Persistent adrenal enhancement may be the earliest CT sign of significant hypovolaemic shock

AIM: To report two cases of intense and persistent adrenal enhancement on computed tomography (CT) examinations of the abdomen. MATERIALS AND METHODS: Two patients presented with septic shock, one due to pyogenic liver abscess and the other strangulated obturator hernia with gangrenous bowel. Both patients were resuscitated with fluid before undergoing unenhanced and enhanced CT. RESULTS: In both patients intravascular volume was not reduced as evident by normal calibre of the aorta and inferior vena cava. One patient had abnormal enhancement pattern in the liver and kidneys, suggesting hypoperfusion. The other patient had normal enhancement pattern of the other abdominal viscera. Both patient subsequently died with multi-organ failure. CONCLUSION: We propose that adrenal enhancement may be a sign of hyperperfusion in early stage of shock due to the crucial role of the adrenal glands in this clinical situation. This may not persist with further circulatory compromise due to vasoconstriction. If confirmed, its recognition has potential value of identifying a therapeutic window before irreversible shock set in. (C) 2003 The Royal College of Radiologists. Published by Elsevier Science Ltd. All rights reserved.