Méhen belül felszívódó magzati mellékvesevérzés ultrahang-diagnózisa

Abstract

The confirmed incidence of new-onset adrenal gland hemorrhage has increased with the development of ultrasound diagnostics in recent years. Intrauterine developed cases are rarely recognized. Differential diagnosis of cystic lesions of the adrenal gland is often only possible after birth. In our case study, we report the ultrasonographic diagnosis and follow-up of a cystic lesion measuring 4 × 3 cm in the left fetal epigastrium in the 33rd gestational week. During pregnancy, multimodal imaging methods (both ultrasound and magnetic resonance) have confirmed the diagnosis of hemorrhage in the left adrenal gland. In the 37th gestational week, the hematoma completely resolved. At term, a 4150 gram neonate was delivered in good condition by an elective cesarean section. Postnatal endocrinological and follow-up ultrasound examinations did not find any disorder. This study is the first published case report in the literature that proves that fetal adrenal hemorrhage can intrauterin spontaneously absorb within a short period of time. Our case draws attention to the fact that adrenal bleeding may occur in the newborn regardless of birth trauma. It can also be assumed that the incidence of adrenal bleeding during pregnancy is higher than that reported in neonatal cases. Orv Hetil. 2019; 160(52): 2073–2078.

Imaging and outcomes of fetal adrenal hemorrhage: A systematic review

“…We included 10 studies in non-English language. 12,14,15,[20][21][22][23][24][25] Our study describes surgical intervention rates in 16 cases from a diverse group of publications, both geographically and chronologically. We found 8 cases from Asia (China, Taiwan, or Korea) between 1999 and 2018, 4 cases from the US between 1993 and 1998, and 4 cases from Europe between 1992 and 2012.…”

“…To our knowledge, this is the first thorough review of the literature with a relatively large sample size of FAH cases. We included 10 studies in non‐English language 12,14,15,20–25 . Our study describes surgical intervention rates in 16 cases from a diverse group of publications, both geographically and chronologically.…”

“…Non-English articles were translated prior to review (n = 10 articles). 12,14,15,[20][21][22][23][24][25] All reports of a prenatally identified fetal adrenal "mass" with a subsequent diagnosis of "FAH" were included. We considered the term "mass" as the broad range of fetal adrenal masses reported on prenatal imaging, while we considered the term "fetal adrenal hemorrhage (FAH)" to be one of the differential diagnoses of a fetal adrenal mass, that is attributed to a hemorrhage of the fetal adrenal gland and is a diagnosis that is described following the identification of the fetal adrenal mass.…”

“…The full text of studies deemed relevant were reviewed for inclusion and exclusion criteria. Non‐English articles were translated prior to review ( n = 10 articles) 12,14,15,20–25 . All reports of a prenatally identified fetal adrenal “mass” with a subsequent diagnosis of “FAH” were included.…”

“…3 Other possible diagnoses of a fetal adrenal mass include infradiaphragmatic extralobar pulmonary sequestration, [4][5][6][7] renal duplication, 1,5,8,9 adrenal, mullerian, ovarian, renal, splenic, gastric, or enteric duplication cyst, 1,4,8 adrenal hyperplasia, [5][6][7]10,11 adrenal calcification, 2 multicystic dysplastic kidney, 7,11 adrenal neuroma or neuroblastoma, 12 perinephric urinoma (secondary to posterior urethral valves), 11 mesoblastic nephroma, 13,14 lymphatic malformation, 5 Wilm's tumor, 8,15,16 teratoma, 10 or Beckwith-Wiedemann syndrome (BWS) associated adrenal carcinoma. 1,[13][14][15] Despite advancements in prenatal imaging techniques and diagnosis, it remains a challenge to reliably distinguish between these different diagnoses. 2 Therefore, postnatal surgical intervention is often reported in the literature to rule out neuroblastoma when a fetal adrenal mass is visualized and persists postnatally, even when FAH is suspected.…”