Ulus Travma Acil Cerrahi Derg. 2020; 26(5): 829-832 | DOI: 10.14744/tjtes.2019.99457

Hemorrhagic adrenal myelolipoma after trauma to left adrenal gland: A case report

Tse-Hao Chen¹, Pei Fang Lai², Yung-hsiang Hsu^3
1Division of Medical Education, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei 231-Taiwan
²Department of Emergency Medicine, Buddhist Tzu Chi General Hospital, Buddhist Tzu Chi Medical Foundation, Hualien 970-Taiwan
³Department of Pathology, Buddhist Tzu Chi General Hospital, Buddhist Tzu Chi Medical Foundation, Hualien 970-Taiwan

Myelolipomas are rare benign tumors comprised of mature adipose tissue and hematopoietic elements. Adrenal myelolipomas associated with traumatic adrenal injury are relatively rare and less common on the left due to the limited size and well-protected position of the gland. A 59-year-old female admitted to the emergency department with intermittent left flank pain radiating to the left abdomen after falling from the bed six hours earlier. Her vital signs were stable, and she had tenderness over the left flank area and left abdomen. Her initial hemoglobin level was 12.9 g/dL. Bedside focused assessment with sonography for trauma revealed unclear left kidney margins. Contrast abdominal computed tomography (CT) revealed a space-occupying mass, 11.6×10.4×8.8 cm in dimension, in the left suprarenal region with active bleeding in the lower pole. Angiography did not reveal any active contrast medium extravasation. The CT-guided biopsy, was well performed concomitantly with angiography. Pathological assessment of the biopsy specimen revealed the presence of mostly adipose tissue with few erythrocytes and leukocytes. She was diagnosed with adrenal myelolipoma and admitted to the urology ward for left adrenalectomy with tumor resection. Traumatic adrenal injury, an unusual presentation of adrenal myelolipoma incidentally found in less than 5% of all abdominal blunt injuries, should be considered in cases of bleeding with trauma to the flank for prompt treatment.

Keywords: Adrenal emergency, adrenal myelolipoma; case report; incidentaloma; traumatic adrenal injury.

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Sol adrenal bezde travma sonrasý hemorajik adrenal miyelolipom: Olgu sunumu

Tse-Hao Chen¹, Pei Fang Lai², Yung-hsiang Hsu^3
1Taipei Tzu Chi Hastanesi, Budist Tzu Chi Týp Vakfý, Týp Eðitimi Bölümü, Yeni Taipei 231-Tayvan
²Budist Tzu Chi Genel Hastanesi, Budist Tzu Chi Týp Vakfý, Acil Týp Departmaný, Hualien 970-Tayvan
³Budist Tzu Chi Genel Hastanesi, Budist Tzu Chi Týp Vakfý, Patoloji Bölümü, Hualien 970-Tayvan

Miyelolipomlar, matür yað dokusu ve hematopoetik elementlerden oluþan nadir iyi huylu tümörlerdir. Travmatik adrenal yaralanma ile iliþkili adrenal miyelolipomlar, bezin sýnýrlý boyutu ve iyi korunan pozisyonu nedeniyle sol tarafta nispeten nadirdir ve daha az yaygýndýr. Elli dokuz yaþýnda kadýn hasta, altý saat önce yataktan düþtükten sonra sol karýn bölgesine yayýlan aralýklý sol yan aðrýsý þikayeti ile acil servise baþvurdu. Vital bulgularý stabildi ve sol yan bölgede ve sol karýn bölgesinde hassasiyeti mevcuttu. Baþlangýç hemoglobin düzeyi 12.9 g/dL idi. Travma için ultrason ile yatak baþý deðerlendirmede sol böbrek sýnýrlarý belirsiz olarak saptandý. Kontrastlý abdominal bilgisayarlý tomografide (BT) sol suprarenal bölgede 11.6×10.4×8.8 cm boyutunda yer kaplayýcý bir kitle ile birlikte alt polde aktif kanama saptandý. Anjiyografide herhangi bir aktif kontrast madde ekstravazasyonu saptanmadý. Anjiyografi ile eþ zamanlý olarak BT eþliðinde biyopsi baþarýlý bir þekilde gerçekleþtirildi. Biyopsi örneðinin patolojik deðerlendirmesi, az sayýda eritrosit ve lökosit içeren çoðunlukla yað dokusunun varlýðýný ortaya koymuþtur. Hastaya adrenal miyelolipom tanýsý konuldu ve tümör rezeksiyonu ile sol adrenalektomi için üroloji servisine yatýrýldý. Tüm künt abdominal yaralanmalarýn %5’inden azýnda tesadüfen bulunan adrenal miyelolipomun olaðandýþý bir sunumu olan travmatik adrenal yaralanma, karýn travmasýna baðlý kanama olgularýnda acil tedavi için dikkate alýnmalýdýr.

Anahtar Kelimeler: Adrenal acil, adrenal myelolipom; insidentaloma; olgu sunumu; travmatik adrenal yaralanma.

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