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The Importance of Sonography in the Evaluation of Neonatal Adrenal Hemorrhage

Orange Coast College, School of Allied Health Professions, Diagnostic Medical Sonography Division, Costa Mesa, California, rinivaldespino{at}aol.com, University of California at Irvine Medical Center, Department of Radiology, Ultrasound Division, Orange, California, Kaiser Permanente Riverside Medical Center, Department of Radiology, Ultrasound Division, Riverside, California

Neonatal adrenal hemorrhage is a relatively common condition of the newborn. Etiologies of neonatal adrenal hemorrhage include maternal/ fetal stress, birth trauma, congenital syphilis, dehydration, anoxia, or other systemic disorders. Clinical presentation ranges from asymptomatic to anemia, hypotension, vomiting, jaundice/hyperbilirubinemia, scrotal discoloration, hyponatremia, and palpable abdominal mass. Adrenal hemorrhage sonographically appears as an abdominal mass with displacement of the kidney inferiorly, known as mass effect. Differentiation of adrenal hemorrhage from more serious pathologies such as adrenal carcinoma, neuroblastoma, or pheochromocytoma is critical. Bluish discoloration of the scrotum may also occur due to extravasation of blood from the hemorrhage, leading to an incorrect diagnosis of testicular torsion or acute scrotum. Proper sonographic evaluation conservatively avoids unnecessary surgical exploration. Power Doppler imaging, color Doppler imaging, and serial gray-scale sonography can document the characteristics and progression of the condition for accurate diagnosis. Sonography is a preferred noninvasive screening modality for evaluating abdominal masses within the pediatric population because of its sensitivity, avoidance of radiation and sedation, and potential value for avoiding exploratory surgery.

Key Words: neonatal adrenal hemorrhage • mass effect • serial sonography • serial imaging • power Doppler imaging • color Doppler imaging

This version was published on July 1, 2009

Journal of Diagnostic Medical Sonography, Vol. 25, No. 4, 221-225 (2009)
DOI: 10.1177/8756479309338954


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