Postpartum Spontaneous Adrenal Hematoma

Abstract

Adrenal hematoma refers to an acute hemorrhage originating from the adrenal gland. When it occurs spontaneously, without an associated traumatic event (the most common cause), it is categorized as spontaneous adrenal hematoma. Spontaneous adrenal hematoma is a very rare condition, particularly during the postpartum period. Although a few cases of adrenal hematoma during pregnancy have been documented in the literature, no cases have been reported during the puerperium. We present the case of a 43-year-old woman who experienced acute right-sided flank pain, fever, and fatigue 3 days after delivering a baby vaginally. Following an angiography-computed tomography (angio-CT) scan to rule out thromboembolism, the radiologist identified a unilateral hemorrhagic mass on the adrenal gland. The management of this adrenal hematoma involved a conservative approach, which included rest and close monitoring to prevent rupture and adrenal insufficiency. Clinical diagnosis of spontaneous adrenal hematoma presents a significant challenge due to its vague and nonspecific symptoms, especially during the puerperium, as these symptoms can overlap with other common postpartum complications. Diagnosis is often incidental and relies on imaging studies. In this particular case, a high degree of clinical suspicion and a thorough diagnostic workup were crucial in achieving the correct diagnosis. Through this case report, we aim to raise awareness and provide a review of the current literature on this exceedingly rare condition.

J Clin Gynecol Obstet. 2023;12(3):102-105
doi: https://doi.org/10.14740/jcgo917