Increased F-18 FDG uptake in resolving atraumatic bilateral adrenal hemorrhage (hematoma) on PET/CT

A 61-year-old woman developed atraumatic bilateral adrenal hemorrhages while on anticoagulation. CT and MRI scans demonstrated enlarged adrenals with typical hemorrhagic features. Sequential CT scans showed gradual resolution of adrenal enlargement. Four months after the bleed, PET/CT was done and showed intense focal F-18 fluoro-2-deoxy-D-glucose (FDG) uptake in both adrenal glands. Malignancy and infection are often at the top of the differential for increased adrenal FDG uptake. Follow-up confirmed that abnormal FDG uptake in this case was secondary to resolving adrenal hemorrhage. This diagnosis should be considered in an appropriate imaging setting when adrenal glands demonstrate increased FDG uptake.