Prenatal sonographic detection of fetal adrenal hemorrhage

Objective 

Detection of prenatal finding of a large cystic adrenal mass causes a dilemma regarding the differential diagnosis between adrenal hemorrhage and cystic neuroblastoma. We report a case of adrenal hemorrhage in a newborn first detected by sonography at a menstrual age of 34 weeks 4 days

Case(s)

A 23-year-old G1P0 pregnant presented to our clinic due to routine follow-up. The patient having a regular menstrual cycle previously was at 34 weeks and 4 days since her last menstrual period (LMP). The patient did not have consanguineous marriage and a hypoechoic cystic lesion not clearly differentiated in diameter of 18,6x17,5 mm was determined in the right kidney region of the fetus at 34 weeks of gestation in the ultrasonography performed (Figure 1). Fetal adrenal hemorrhage and cystic neuroblastoma prediagnoses were made in the detailed ultrasonography performed and no additional anomaly was determined. It was learned from the history of the patient she had the second trimester screening tests and the third trimester screening tests previously and determined to have normal values. The patient was informed regarding there could be an additional anomaly. Since the patient was in a late gestational week and she did not want to have, amniocentesis was not performed. The routine laboratory and tumor marker levels were normal. It was observed that the tumor was reduced in size during the routine follow-up of pregnancy. She had normal delivery in the 39th gestational week. No pathological finding was encountered in the newborn infant. No pathological finding was observed in the kidney, liver and bile ducts in the ultrasonography and MRI performed. An area of fetal adrenal hemorrhage with a mildly heterogeneous echo texture in diameter of 5,8x4,7 mm was determined in fetal adrenal region (Figure 2). Since complete blood count results, blood chemistry tests and tumor marker values were within normal ranges, the infant was followed-up. Ultrasonography was performed every two weeks. It was seen that hemorrhagic area was gradually reduced. Since the cyst was no seen and laboratory findings were found to be normal in the infant at the end of the month, the follow-up was ended.

Results

The thought of a neuroblastoma is generally resulted in surgical excision of this lesion. However, to avoid an unnecessary surgery, an adrenal hemorrhage has to be diagnosed in due time. Close postnatal follow-up should be performed with serial ultrasonography in order to make differential diagnosis of such tumors even in large masses. Unless the tumor size does not reduce, surgical treatment is not essential. Nonetheless, it is impossible to make a differential diagnosis between an adrenal hemorrhage and a spontaneously resolved neuroblastoma.

Conclusion 

Our case implies that adrenal hemorrhage may develop as early as the second trimester of the pregnancy.

Keywords

Adrenal hemorrhage, fetal adrenal hemorrhage

	File/Dsecription
	Figure 1 A hypoechoic cystic lesion in the right kidney region of the fetus at 34 weeks of gestation.
	Figure 2 Ultrasonographic appearance of an area of adrenal hemorrhage with a mildly heterogeneous echo texture in diameter of 5,8x4,7 mm in fetal adrenal region of a newborn infant.