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Sequential Adrenal Infarction Without MRI-Detectable Hemorrhage in Primary Antiphospholipid-Antibody Syndrome

¹ Both authors: Department of Medical Imaging, Toronto General Hospital, University Health Network, 200 Elizabeth St., Toronto, ON M5G 2C4, Canada.

View larger version (146K): [in a new window]   Fig. 1A. —42-year-old man who presented with left flank pain and was given provisional diagnosis of renal colic. Unenhanced CT scan shows enlarged left adrenal gland (arrow), which is of normal attenuation. Note mild inflammatory change in surrounding fat.

View larger version (157K): [in a new window]   Fig. 1B. —42-year-old man who presented with left flank pain and was given provisional diagnosis of renal colic. Fast spoiled gradient-recalled echo coronal out-of-phase T1-weighted MR image obtained 2 days after A shows homogeneous intermediate signal intensity (arrow) throughout enlarged left adrenal gland. Note normal contralateral adrenal gland.

View larger version (134K): [in a new window]   Fig. 1C. —42-year-old man who presented with left flank pain and was given provisional diagnosis of renal colic. Coronal T1-weighted gadolinium-enhanced MR image depicts capsular but no parenchymal enhancement (arrow) in infarcted left adrenal gland.

View larger version (160K): [in a new window]   Fig. 1D. —42-year-old man who presented with left flank pain and was given provisional diagnosis of renal colic. Repeated fast spoiled gradient-recalled echo axial out-of-phase T1-weighted MR image, obtained 4 days after first presentation (A) due to contralateral pain, confirms thickening of right adrenal gland (arrow), which is of homogeneous intermediate signal, together with previously shown swollen left adrenal gland (A and B). No evidence of hemorrhage is seen in either gland.

View larger version (147K): [in a new window]   Fig. 1E. —42-year-old man who presented with left flank pain and was given provisional diagnosis of renal colic. Axial T1-weighted gadolinium-enhanced image shows lack of contrast enhancement in both adrenal glands consistent with infarction. Note that degree of capsular enhancement in left adrenal gland is now less than that on previous MR image (C) and is less than that in right adrenal gland (arrow).

View larger version (147K): [in a new window]   Fig. 1F. —42-year-old man who presented with left flank pain and was given provisional diagnosis of renal colic. Follow-up CT scan obtained 4 months after first admission (A) shows that left adrenal gland (arrow) is now atrophic, and only small nodule of tissue in right adrenal gland (arrowhead) remains.

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