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Case of the Month

December 2007

Patient Data: Male neonate 9 days old

Clinical Info: Incidental finding during an examination of the kidneys

Longitudinal image of the mass cranial to the right kidney

Transverse image of the mass cranial to the right kidney

Longitudinal image of the normal right kidney and the mass

Transverse image of the normal right kidney (lateral) and the mass (medial)

The mass shows no vascularity with color doppler

Longitudinal image of the normal left adrenal

Transverse image of the normal left adrenal Discussion A non vascularized partly cystic mass in the adrenal in a neonate is suggestive for an adrenal hemorrhage. However in the case of an adrenal mass in a neonate a neuroblastoma should always be considered. Neonatal asphyxia, sepsis, trauma or a systemic coagulopathy are cosidered potential causes for an adrenal hemorrhage. Adrenal hemorrhage is more common in neonates than in older children or adults. At birth, the adrenal gland weighs up to twice as much as the adult adrenal gland. During the first weeks of life, rapid regression occurs. Pathologic studies suggest that in neonates, adrenal hemorrhage is almost always preceded by ischemic necrosis. A neonatal adrenal hemorrhage is identified in les than 2 per 1000 births. A unilateral adrenal hemorrhage is rarely of clinical significance and is treated coservatively. An adrenal hemorrhage can also occur in adult patients. In these cases an adrenal tumor causing the hemorrhage must always be excluded.

Transverse image of an adrenal hemorrhage in a 39 year old female (without tumor)

For more cases of adrenal hemorrhage and other adrenal pathology see

Velaphi SC, Perlman JM.Neonatal adrenal hemorrhage: clinical and abdominal sonographic findings.
Clin Pediatr (Phila). 2001 Oct;40(10):545-8. Review

Paterson A.Adrenal pathology in childhood: a spectrum of disease.
Eur Radiol. 2002 Oct;12(10):2491-508..

Nadler EP, Barksdale EM.Adrenal masses in the newborn.
Semin Pediatr Surg. 2000 Aug;9(3):156-64. Review.

Copyright © Dr. T.S.A. Geertsma, Ziekenhuis Gelderse Vallei, Ede, The Netherlands. All rights reserved.

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