[Echography in the diagnosis of neonatal adrenal hemorrhage]

Neonatal adrenal gland hemorrhage is not uncommon. Its etiology is still questionable, though hypoxia (antenatal, labor-induced, or neonatal) seems to be usually associated with the event. Symptoms include acute shock associated with severe blood loss. Milder cases exhibit anemia and jaundice associated with a suprarenal mass. Ultrasonography (US) has replaced urography in the diagnosis of this condition, demonstrating site and size of the lesion and allowing an accurate follow-up. The authors report on a series of 11 patients; US was performed on 9 of them. In 10 cases the lesion was unilateral and in one case bilateral. Antenatal US diagnosis was possible in 2 cases and confirmed neonatally. The extant 9 infants developed a palpable abdominal mass or were diagnosed while examined for other conditions. All cases were evident by the 2nd week of life. Eight patients exhibited spontaneous hemorrhage resolution, as shown by repeated US and/or urographic exams. Three patients underwent surgery because the lesion seemed stable. In these 3 instances, CT scans were inconclusive. This paper is aimed at reporting on the radiologic and US features we observed, with a special emphasis on the changes in size, shape and US features in the cases which resolved spontaneously. The first US examination is not conclusive and does not allow an unquestionable differential diagnosis. Only lesion evolution with progressive decrease in its size (changes in US features are less useful) allows unquestionable US diagnosis and prevents unnecessary surgery.