Fetal adrenal hemorrhage

Case contributed by Dr Rania Adel Anan

Presentation

Incidental finding during third trimester Doppler study for decreased fetal movement. Gestational diabetes and hypertension were present.

Patient Data

Age: fetus 35 weeks gestation
Gender: Male

Antenatal ultrasongraphy:

Ultrasound

A well defined intra-abdominal anechoic cystic lesion (about 3 3.8 cm) with thick echogenic internal septations seen at the right supra-renal region,  compressing the upper pole of the right kidney. Doppler scan (not shown) revealed no internal vascularity. 

Both kidneys were normal in size and shape with no detected abnormalities.

The rest of the study was unremarkable.

Neonatal abdominal ultrasonography:

Ultrasound

A well defined  anechoic cystic lesion with thick debris and thick echogenic septations inside seen at the right supra-renal region,  compressing the upper pole of the right kidney. No internal vascularity noted on Doppler interrogation.

Case Discussion

Pregnant female patient with gestational diabetes and hypertension complained during her 35th weeks gestation of decreased perception of the fetal movement. During Doppler study recommended by the clinician, fetal intra-abdominal cystic lesion was incidentally seen at the right adrenal region and reported as fetal adrenal hemorrhage.

Few hours after delivery, neonatal abdominal ultrasonography was done & confirmed the previously noted adrenal hemorrhage and Follow up was recommended.

 Fetal adrenal hemorrhage is an uncommon occurrence and must be differentiated from other lesions especially neuroblastoma.

It can occur unilaterally or bilaterally. There is a greater incidence on the right side (75%) because anatomically, the right adrenal gland is located between the liver and spine and thus, can result in its compression. Moreover, the right adrenal vein drains into the inferior vena cava and its compression can induce venous pressure changes.

 Neonatal adrenal hemorrhage is usually self-limited with resolution. It becomes anechoic at approximately 2 to 3 months after onset and on rare instances extends to a maximum of 9 months.    

Ultrasonography remains the modality of choice for evaluation of the adrenal glands in neonates.

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