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Virtual Pediatric Hospital: Paediapaedia: Neonatal Adrenal Hemorrhage Paediapaedia: Genitourinary Diseases

Neonatal Adrenal Hemorrhage

Michael P. D'Alessandro, M.D.
Peer Review Status: Internally Peer Reviewed


Clinical Presentation:
Most commonly present with an abdominal mass and anemia and or jaundice due to reabsorption of the hematoma. Adrenal insufficiency is rare, even with bilateral hemorrhage.

Etiology/Pathophysiology:
Due to birth trauma, perinatal stress associated with anoxia or dehydration, and systemic disorders such as thrombocytopenia, septicemia, and congenital syphilis. Seventy percent involves the right adrenal while 5-10% are bilateral. Usually has spontaneous resolution in 4-6 weeks.

Pathology:
Not applicable

Imaging Findings:
Initially on ultrasound it will appear as an anechoic suprarenal mass with variable compression and displacement of the kidney. Rarely the hematoma will appear as echogenic and complex and is difficult to distinguish from neonatal neuroblastoma. Repeating the ultrasound in a month allows the two to be distinguished as by then neonatal hemorrhage should have either turned cystic in appearance or resorbed.

Two weeks after hemorrhage calcification can develop on the abdominal plain film.

DDX:

References:
See References Chapter.

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