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Case of the Month

August 2010

Patient Data: 1 week old male neonate

Clinical Info: Jaundice

Hypoechoic mass between the liver and right kidney

Hypoechoic mass cranial to the left kidney

The mass on the right side shows cystic spaces

The mass displaces the right kidney

The right kidney is normal

The mass on the left side impresses the upperpole of the left kidney. A thin layer of normal adrenal tissue can be recognized

The mass displaces the left kidney

The left kidney is normal

The hypoechoic mass lesions cranial to both kidneys are caused by an adrenal hemorrhage. An adrenal hemorrhage in neonates is uncommon
According to autopsy reports, neonatal adrenal hemorrhage is identified in 1.7 per 1000 births. Others report an incidence of 2 to 4 cases out of 1000 newborns An adrenal hemorrhage can occur prenatally or postnatally. The most important causes are birth trauma, neonatal asphyxia, systemic disorders and newborn sepsis. With 70%, the right adrenal gland is affected more frequently than the left. Bilateral hemorrhage occurs in about 5 - 10%
The clinical signs and symptoms of an adrenal hemorrhage can be an abdominal mass, anemia, jaundice, hypotension or a bluish discoloration of the scrotum
The ultrasound characteristics of an adrenal hemorrhage vary depending to the extend of the hemorrhage and the time between the examination and the onset of the hemorrhage. In the acute phase the hemorrhage may be hyperechoic, but in most of the reported cases the hemorrhage is in a hypoechoic stage, sometimes with cystic spaces. Over time the hemorrhage resolves, but sometimes leads to adrenal calcifications.
The course of an adrenal hemorrhage as in this case is usually uneventful and surgical intervention is rarely indicated
Sometimes a corticosteroid substitution may be necessary

For more examples of neonatal adrenal hemorrhage and normal neonatal adrenals see:

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

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