Imaging description

A seven-day-old neonate presented with a history of birth asphyxia and abdominal distension. A routine abdominal-renal ultrasound demonstrated incidental heterogeneous lesions in the bilateral suprarenal regions (Fig. 70.1). The lesions were relatively well defined, with mild compression of the upper poles of both kidneys. A review of prenatal ultrasound images (not shown) did not reveal any evidence for adrenal masses. The finding is most consistent with bilateral adrenal hemorrhages. A neuroblastoma is much less likely due to the bilateral nature of the lesions and the history of an acute occurrence.

Importance

The adrenal gland in neonates is large and susceptible to hemorrhage due to rapid regression of the fetal cortex during the neonatal period and markedly engorged vascular channels in the primitive cortex. Adrenal hemorrhage is postulated to occur either due to ischemic hemorrhagic infarction because of reflex vascular redistribution in response to asphyxia or rupture of engorged veins related to increased abdominal pressure and inferior vena cava (IVC) compression. A significant hemorrhage can result in hypovolemic shock and may present as a life-threatening emergency. In neonates, the development of adrenal insufficiency is rare.