Fetal Adrenal Haemorrhage – Two-Dimensional and Three-Dimensional Imaging

Abstract

A case of prenatal adrenal haemorrhage first detected by 2-dimensional and 3-dimensional sonography at 27 weeks’ gestation is reported. Ultrasound examination showed a large cystic mass (32 × 27 × 27 mm) in the right suprarenal region of the fetus. Two weeks later, the mass had slightly increased in size demonstrating hyperechoic areas within the cyst. Further serial ultrasound examinations revealed a progressive organisation of the cystic mass associated with a moderate reduction in size. The diagnosis of adrenal haemorrhage was confirmed by postnatal follow-up sonograms as the mass decreased in size from 28 × 21 × 21 mm on day 1 to 23 × 18 × 17 mm on day 42. Course and sonographic signs were typical for adrenal haemorrhage and the neonate was therefore managed without surgical exploration. The child is developing normally at 6 months of age.

Prenatal Diagnosis of Adrenal Neuroblastoma: A Case Report with a Brief Review of the Literature

“…Patients with cystic neuroblastoma had a better outcome than those noncystic tumors [7]. The main differential diagnosis is adrenal haemorrhage which is the most common cause of adrenal mass during the perinatal period with an incidence of 1, 9/1000 live births [8]. It is important to differentiate benign adrenal lesions like adrenal hemorrhage or adrenal cysts from neuroblastoma.…”

The Importance of Sonography in the Evaluation of Neonatal Adrenal Hemorrhage

“…The adrenal glands are especially vulnerable to hemorrhage due to birth trauma because of their size (approximately 20 times the relative size in the adult) and high vascularity with supply from the inferior phrenic artery, abdominal aorta, and renal artery. 2 Adrenal hemorrhage involvement of the right side is more common than the left side, is bilateral in 10% to 15% of cases, and is presumed to be secondary to compression of the adrenal gland between the liver and the spine. 3 The right adrenal vein is of shorter length because of its proximity to the inferior vena cava (IVC); its compression between the liver and spine increases venous pressure within the adrenal gland, subsequently inducing hemorrhage.…”

“…Eventually, the mass becomes completely anechoic. 2 Complete resolution of the hemorrhage will appear as a residual echogenic calcification. Adrenal hemorrhage will appear avascular in contradiction to highly vascular malignancies.…”

What is your diagnosis?

“…Most hemorrhages are reported to occur at birth or during the early neonatal period. Despite these ultrasonographic findings, the prenatal detection rate is much lower than the postnatal life (9). This is probably because adrenal glands are often omitted during prenatal evaluation.…”