An adrenal nodule

8 year old male was running in the street when he got hit by a car. He had immediate onset of abdominal and back pain, and was brought to the emergency department. A CT scan was obtained. A 3.9 x 2.2 cm right adrenal "nodule" was discovered. Attenuation of the nodule was about 46 HU.

On spectral analysis, the nodule attenuation remains same on virtual non-contrast, and there is no iodine uptake in the nodule. This is diagnostic of an adrenal hematoma, and does not require any further workup.

Spectral CT very elegantly problem-solves in trauma scans, just as in any other scans, and increases radiologist confidence. It is also a great teaching tool to demonstrate to residents a diagnosis that may be obvious to those of us with experience, but may not be so obvious to someone starting out. 

Conventional CT shows right adrenal nodule. Note normal left adrenal gland.

Conventional axial image, right adrenal nodule with attenuation of 46 HU. Notice small amount of fluid/hemorrhage adjacent to the nodule.

Virtual non-contrast: Attenuation in the adrenal nodule remains the same

Iodine map: Absolutely no iodine uptake in the adrenal nodule, consistent with a hematoma