August 2010

Hypoechoic suprarenal mass on both sides (Image shows the right side)

Clinical Info

1 week old male neonate
Jaundice

Ultrasound Images & Clips

Hypoechoic mass cranial to both kidneys

Hypoechoic mass between the liver and right kidney
Hypoechoic mass between the liver and right kidney
Hypoechoic mass cranial to the left kidney
Hypoechoic mass cranial to the left kidney
The mass on the right side shows cystic spaces
The mass on the right side shows cystic spaces
The mass displaces the right kidney
The mass displaces the right kidney
The right kidney is normal
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 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 mass displaces the left kidney
The left kidney is normal
The left kidney is normal

Conclusion

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


Details

  • Sex: Male

Created with

  • Hitachi Ultrasound System