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| Year : 2000 | Volume
: 10
| Issue : 1 | Page : 41-42 |
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| Radiological quiz - abdomen |
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Chhaya J Bhatt, Hemali J Desai
Dept of Radiology, B.J.M.C. and Civil Hospital, Ahmedabad, India
Click here for correspondence address and email
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How to cite this article:
Bhatt CJ, Desai HJ. Radiological quiz - abdomen. Indian J Radiol Imaging 2000;10:41-2 |
A one-month old neonate born prematurely (after a gestation of 32 weeks), presented with an abdominal mass for twenty days, high-grade fever, continuous crying and apathy for ten days. Clinically the patient was in septicemia. On examination, a lump was palpable in both flanks.
Ultrasound examination revealed bilateral large, well-circumscribed anechoic masses with marginal calcification displacing both kidneys inferiorly.
Plain and contrast enhanced CT examination showed non-enhancing hypodense masses with marginal calcification displacing both kidneys inferiorly [Figure - 1],[Figure - 2].
 View Answer
 Radiological diagnosis | |  |
BILATERAL NEONATAL ADRENAL HEMORRHAGEHemorrhage in the adrenal glands is a relatively common disorder of neonates. Neonatal adrenal glands are relatively huge weighing 8gm, against the adult weight of 5gms. Soon after birth the bulk of the primitive adrenal cortex undergoes atrophy. This leads to engorgement of the dilated vascular channels, which are then vulnerable to hemorrhage. The bleeding is usually confined to the subcapsular space [1]. The exact cause of adrenal hemorrhage is unknown but factors which have been implicated are stress, trauma at birth, anoxia and systemic diseases such as purpura, hemorrhagic disease of the newborn, septicemia and congenital syphilis [2]. Trauma appears to be the most common factor. Most frequently these patients present within 2-7 days of life with an abdominal mass that is usually located on the right side. The right adrenal gland is involved in 70% of patients whereas bilateral involvement is seen in 10% of patients. The right adrenal gland is commonly affected because of easier transmission of any pressure changes from the IVC through the short right adrenal vein [3]. Plain radiographs may not be of help except in later stages when calcification is seen in the suprarenal region. Ultrasound examinations reveal suprarenal hematomas as masses with a mixed echo pattern containing variable degree of internal echoes. Later they become echolucent as liquefaction of hemorrhage occurs over several weeks and marginal calcification develops. Recent adrenal hemorrhage is readily seen on CT as high-density lesions (50-70 HU). As the hemorrhage regresses, the attenuation value becomes lower than that of soft tissue but remains higher than that of water [4]. Later, the masses develop marginal calcification. Differential diagnoses include neuroblastoma, adrenal cysts, tumors (ganglioneuroma, pheochromocytoma, cortical carcinoma). Serial ultrasound scanning helps in the follow-up of these patients. Bilateral adrenal hemorrhage is self-limiting and spontaneous resolution is the usual outcome.
| References | | |
| 1. | Pery M, Kaftori JK, Bar-Maor JA. Sonography for diagnosis and follow up of adrenal hemorrhage. J Clin Ultrasound 1981; 9: 397.  [PUBMED] |
| 2. | Mittelstaedt CA, Volberg FM, Merten DF, Brill PW. The sonographic diagnosis of neonatal adrenal hemorrhage. Radiology 1979; 131: 453-457. [PUBMED] |
| 3. | Balakumar K et al . Evaluation of asymptomatic neonatal unilateral adrenal hemorrhage - ultrasonographic diagnosis. Ultrasound International 1998; 4: 51-52. |
| 4. | Korobkin LM, Silverman PM and Dunnick NR. CT demonstration of bilateral adrenal hemorrhage. Am J Roentgenol 1983; 141: 307-308. |
Correspondence Address:
Chhaya J Bhatt
A/28, Ashok Tenaments.Opp.Cadila, Ghodasar, Ahmedabad 380 050
India
 Source of Support: None, Conflict of Interest: None  | Check |
Figures
[Figure - 1], [Figure - 2] |
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