[Adrenal Hemangioma of Atypical Presentation. Bibliographical Review]

Objective: To report a case of adrenal hemangioma presenting as spontaneous massive retroperitoneal hemorrhage that required surgical treatment without preoperative hormonal study.

Methods/results: Due to the intense pain and hemodynamic instability, the patient described herein was immediately submitted to laparatomy, adrenalectomy and drainage. The literature is reviewed with special reference to the clinical and radiological findings that could permit making a correct preoperative diagnosis. To our knowledge, a similar form of presentation has not been reported in the literature. The patient is asymptomatic 8 months postoperatively.

Conclusions: Adrenal hemangioma is a rare tumor that usually presents as an incidental finding or with chronic pain in the abdominal flank. Although it is rarely malignant and some authors advocate conservative management based on the radiological findings, the difficulty lies in the similar evolution of other adrenal tumors that can produce similar findings. We therefore advocate surgical excision of adrenal incidentalomas due to their indeterminate histological and clinical behaviour.