Fetal adrenal hemorrhage is an uncommon occurrence and must be differentiated from other lesions especially neuroblastoma.
The exact cause of adrenal bleeding in utero is not well known at the time of writing. It has been associated with birth trauma (breech birth), perinatal asphyxia, sepsis, and congenital infections (classically syphilis) 8-9.
It can occur unilaterally or bilaterally. There is a greater incidence on the right side (75%) 9.
An adrenal hemorrhage may be seen as a mass above the fetal kidneys and will demonstrate changing characteristics in terms of echotexture on sequential images as it evolves from hyperechoic to isoechoic to hypoechoic and finally anechoic cystic are with or without septations. Color Doppler interrogation will not show any associated intrinsic vascularity. The hematoma may also change in size through time. Calcification of the adrenal may be the consequence of prior hemorrhage (although calcification is also seen in neuroblastoma) 9.
For a fetal adrenal mass consider:
- 1. Hsieh CC, Chao AS, Hsu JJ et-al. Real-time and power Doppler imaging of fetal adrenal hemorrhage. Chang Gung Med J. 2005;28 (12): 860-5. - Pubmed citation
- 2. Vollersen E, Hof M, Gembruch U. Prenatal sonographic diagnosis of fetal adrenal gland hemorrhage. Fetal. Diagn. Ther. 11 (4): 286-91. - Pubmed citation
- 3. Schwärzler P, Bernard JP, Senat MV et-al. Prenatal diagnosis of fetal adrenal masses: differentiation between hemorrhage and solid tumor by color Doppler sonography. Ultrasound Obstet Gynecol. 1999;13 (5): 351-5. doi:10.1046/j.1469-0705.1999.13050351.x - Pubmed citation
- 4. Schrauder MG, Hammersen G, Siemer J et-al. Fetal adrenal haemorrhage--two-dimensional and three-dimensional imaging. Fetal. Diagn. Ther. 2008;23 (1): 72-5. doi:10.1159/000109230 - Pubmed citation
- 5. Ceola AF, Angtuaco TL. US case of the day. Extralobar pulmonary sequestration. Radiographics. 19 (3): 817-9. Radiographics (full text) - Pubmed citation
- 6. Fang SB, Lee HC, Sheu JC et-al. Prenatal sonographic detection of adrenal hemorrhage confirmed by postnatal surgery. J Clin Ultrasound. 1999;27 (4): 206-9. J Clin Ultrasound (link) - Pubmed citation
- 7. Benacerraf BR. Ultrasound of fetal syndromes. Churchill Livingstone. (2008) ISBN:0443066418. Read it at Google Books - Find it at Amazon
- 8. Entezami M, Albig M, Knoll U et-al. Ultrasound Diagnosis of Fetal Anomalies. Thieme. (2003) ISBN:1588902129. Read it at Google Books - Find it at Amazon
- 9. Copel J. Obstetric Imaging: Expert Radiology series (Expert Consult Premium Edition - Enhanced Online Features and Print), 1e. Saunders. ISBN:1437725562. Read it at Google Books - Find it at Amazon