Adrenal hemorrhage

Rakhee Gawande, Rosalinda Castaneda, Heike E. Daldrup-Link

Research output: Chapter in Book/Report/Conference proceedingChapter


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.

Original languageEnglish (US)
Title of host publicationPearls and Pitfalls in Pediatric Imaging
Subtitle of host publicationVariants and Other Difficult Diagnoses
PublisherCambridge University Press
Number of pages3
ISBN (Electronic)9781139084239
ISBN (Print)9781107017498
StatePublished - Jan 1 2012
Externally publishedYes

ASJC Scopus subject areas

  • General Medicine


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