What exactly is an adrenal haemangioma, and why is it considered a surprise when it ruptures?

An adrenal haemangioma is a rare, benign vascular tumor that occurs in the adrenal gland. They are typically non-functional, meaning they do not disrupt hormone production. Most are discovered incidentally during imaging for other conditions or during autopsies. In rare cases, these tumors can spontaneously rupture, leading to significant internal bleeding.

In non-traumatic emergencies, how does a retroperitoneal hemorrhage typically lead doctors to suspect an aortic issue, and what makes a ruptured adrenal haemangioma different?

Retroperitoneal hemorrhage is bleeding in the space behind the abdominal cavity, often pointing to a rupture of the abdominal aorta or another major vessel aneurysm. However, spontaneous ruptures of adrenal masses, including rare vascular tumors known as haemangiomas, present a diagnostic challenge. While adrenal incidents typically involve more malignant masses, such as phaeochromocytomas, myelolipomas, cortical adenomas, adrenocortical carcinomas, or metastatic tumors, a benign adrenal haemangioma causing such acute bleeding is exceedingly rare.

The article mentions advances in imaging techniques like CT angiography. How helpful are these techniques in diagnosing a ruptured adrenal haemangioma, especially in emergency situations, and what are their limitations?

While CT angiography can be invaluable, it is most effective on stable patients. In unstable patients, like the one described, time is of the essence, and immediate exploratory surgery might be necessary. The surgical approach allows for direct visualization and intervention but relies on the surgeon's ability to identify the often-obscured source of bleeding, which can be challenging when dealing with rare conditions like a ruptured adrenal haemangioma.

Surreal digital illustration of ruptured adrenal gland.

Adrenal Gland Surprises: When a Benign Tumor Mimics a Rupture

Q: In the presented case, what did the surgical team discover during the exploratory laparotomy that ultimately revealed the actual cause of the patient's condition?

During the exploratory laparotomy, the surgical team discovered a large left-sided retroperitoneal hematoma with blood surrounding the splenic hilum. Suspecting a ruptured splenic artery aneurysm, they performed a Mattox maneuver, including a splenectomy, to fully expose the abdominal aorta. Post-splenectomy, the inspection revealed the source of bleeding to be a disintegrated left adrenal gland, fragmented within a mass of thrombus and serosanguinous fluid.

Q: Is it common to mistake a ruptured adrenal haemangioma for a ruptured aortic aneurysm, and why did this misdiagnosis occur in the described scenario?

While it is true that a ruptured aortic aneurysm is a life-threatening condition requiring immediate intervention, the case highlights that there can be diagnostic challenges. This case specifically demonstrates that a spontaneous rupture of an adrenal haemangioma, a rare, benign tumor of the adrenal gland can mimic a ruptured aortic aneurysm. This distinction is important because the treatment approaches can differ, highlighting the need for vigilance in diagnosing rare conditions.

Nico Varela in Health & Wellness November 2025 • 5 min read.

"Discover the rare occurrence of adrenal haemangiomas spontaneously rupturing, mimicking life-threatening conditions like aortic aneurysm rupture."

Imagine a sudden, sharp pain in your side, so intense that it sends you to the emergency room. Doctors suspect a ruptured aortic aneurysm, a life-threatening condition requiring immediate intervention. But what if the real culprit was something far less common: a spontaneous rupture of an adrenal haemangioma, a rare, benign tumor of the adrenal gland? This unexpected scenario highlights the diagnostic challenges and critical decisions that healthcare professionals face in emergency situations.

In the realm of non-traumatic emergencies, a retroperitoneal hemorrhage—bleeding in the space behind the abdominal cavity—often points to a rupture of the abdominal aorta or another major vessel aneurysm. However, spontaneous ruptures of adrenal masses, including rare vascular tumors known as haemangiomas, present a diagnostic curveball. While adrenal incidents typically involve more malignant masses, such as phaeochromocytomas, myelolipomas, cortical adenomas, adrenocortical carcinomas, or metastatic tumors, a benign adrenal haemangioma causing such acute bleeding is exceedingly rare.

Adrenal haemangiomas are uncommon, often found incidentally during imaging for other conditions. These tumors are typically non-functional, meaning they don't disrupt hormone production, and are usually diagnosed as unilateral masses. Due to their rarity, fewer than 40 cases have been documented in medical literature. More often, these vascular tumors are asymptomatic and discovered during autopsies. But, in very rare instances, they can lead to life-threatening hemorrhages, complicating diagnosis and demanding prompt surgical intervention.

The Case Unfolds: A Diagnostic Puzzle

Surreal digital illustration of ruptured adrenal gland.

Consider the case of a 45-year-old male who presented to the emergency department with acute pain in the left lumbar region, accompanied by nausea and flatulence. His symptoms pointed towards a severe internal issue. Pale and in a cold sweat, his systolic blood pressure plummeted to 70 mmHg, despite a heart rate of 80 bpm, signaling significant blood loss. Palpation revealed tenderness in the left lower quadrant and epigastrium, but no palpable intra-abdominal mass or signs of peritoneal irritation were present. The diagnostic path was unclear, further complicated by the patient’s quickly deteriorating condition.

Initial abdominal ultrasonography revealed an irregular, heterogeneous mass in the retroperitoneal space near the splenic hilum, along with fluid accumulation in the left subphrenic space. The aorta's contours were indistinct, and the left kidney was displaced inferiorly. These findings heightened suspicions of a vascular catastrophe but didn't pinpoint the exact source. Rapid resuscitation efforts with intravenous fluids temporarily stabilized the patient, allowing for a critical, though risky, next step: a CT scan.

Ultrasonography hinted at a retroperitoneal mass.
Initial stabilization allowed for a CT scan attempt.
Symptoms returned during the CT scan, leading to emergency surgery.
Surgical exploration revealed a ruptured adrenal haemangioma.

However, during the CT scan, the patient's condition deteriorated again, exhibiting signs of hypovolemic shock. Responding rapidly, medical staff administered another infusion of intravenous fluids. The urgent need for intervention led to an exploratory laparotomy. The surgical team discovered a large left-sided retroperitoneal hematoma with approximately 200 ml of blood surrounding the splenic hilum. Suspecting a ruptured splenic artery aneurysm, they performed a Mattox maneuver, including a splenectomy, to fully expose the abdominal aorta. Post-splenectomy and after clamping the abdominal aorta, inspection revealed the source of bleeding to be a disintegrated left adrenal gland, fragmented within a mass of thrombus and serosanguinous fluid.

The Takeaway: Rare Diagnoses Demand Vigilance

This case underscores the importance of considering rare diagnoses in emergency scenarios. While retroperitoneal hemorrhage often points to major vessel ruptures, adrenal haemangiomas, though rare, should be on the differential diagnosis, especially when initial imaging is inconclusive. Advances in imaging techniques, such as CT angiography, performed on stable patients, can aid in accurate and timely diagnoses, potentially minimizing unnecessary surgical interventions. Rapid surgical intervention with meticulous dissection and effective haemostasis can lead to successful outcomes, but understanding the potential for atypical presentations is crucial for optimal patient care.

Adrenal Gland Surprises: When a Benign Tumor Mimics a Rupture

"Discover the rare occurrence of adrenal haemangiomas spontaneously rupturing, mimicking life-threatening conditions like aortic aneurysm rupture."

The Case Unfolds: A Diagnostic Puzzle

The Takeaway: Rare Diagnoses Demand Vigilance

Everything You Need To Know

What exactly is an adrenal haemangioma, and why is it considered a surprise when it ruptures?

In non-traumatic emergencies, how does a retroperitoneal hemorrhage typically lead doctors to suspect an aortic issue, and what makes a ruptured adrenal haemangioma different?

In the presented case, what did the surgical team discover during the exploratory laparotomy that ultimately revealed the actual cause of the patient's condition?

Is it common to mistake a ruptured adrenal haemangioma for a ruptured aortic aneurysm, and why did this misdiagnosis occur in the described scenario?

The article mentions advances in imaging techniques like CT angiography. How helpful are these techniques in diagnosing a ruptured adrenal haemangioma, especially in emergency situations, and what are their limitations?

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