Neonatal Adrenal Hemorrhage Associated with Scrotal Hematoma: An Unusual Case Report and Literature Review

Lai, Li-Jen; Chen, Li-Mien; Chu, Pen–Yuan; Tseng, Min-Hua; Chang, Chen-Chu; Lu, Chien-Wei

doi:10.1016/j.pedneo.2012.04.010

Cited by 25 publications

(20 citation statements)

References 22 publications

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“…To our knowledge, this is the first case of idiopathic scrotal haematoma associated with cryptorchidism. Association of scrotal haematoma with adrenal haemorrhage is reported in the literature [11,12] but it was not present in our case. In the recent literature, only a study by Diamond et al reported five cases of scrotal haematoma mimicking testicular torsion [13]; four of five patients had risk factors for developing a scrotal haematoma.…”

Section: Discussioncontrasting

confidence: 59%

Idiopathic scrotal hematoma simulating a testicular torsion, in association with cryptorchidism: US findings

et al. 2014

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SummaryBackgroundAn acute scrotum concerns endoscrotal organs (testicles, spermatic cord, tunica vaginalis) and is characterized by pain, swelling and hyperemia of the hemi-scrotum. It represents one of the most common surgical emergencies in children often caused by testicular torsion; the diagnosis is mostly clinical but must be supported by ultrasonographic examination of the scrotal region in association with a colour Doppler study of the spermatic cord vessels and glandular parenchyma. An idiopathic scrotal hematoma is a very rare condition that can simulate it.Case ReportA 3-day-old full-term baby, otherwise in good health, showed swelling and pain of the left inguinal-scrotal region. A testicular torsion was suspected, so the baby underwent an ultrasound examination of the testis and spermatic cord that showed a left scrotal hematoma with superior displacement of the didymus; the right testicle was located in the internal inguinal canal. Surgical intervention confirmed the sonographic diagnosis of left testicular hematoma and of the right cryptorchidism.ConclusionsAlthough testicular torsion is the most frequent cause of acute scrotum, the possibility of a persistent idiopathic scrotal haematoma and/or haematoma secondary to a trauma of the inguino-scrotal region, must be always taken into account. US diagnosis can avoid unnecessary emergency surgical treatment, required in case of testicular torsion.

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Section: Discussioncontrasting

confidence: 59%

Idiopathic scrotal hematoma simulating a testicular torsion, in association with cryptorchidism: US findings

et al. 2014

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“…He was monitored clinically and radiologically with good outcome. This modality was documented by other workers [8]. Surgical exploration is only indicated if conservative protocol fails or if the hematoma becomes infected.…”

Section: Discussionmentioning

confidence: 95%

“…Few cases of adrenal hemorrhage induced hemoscrotum have been reported in the literature [1, 8, 12]. The condition could be spontaneous or may follow difficult or traumatic delivery [8].…”

Section: Discussionmentioning

confidence: 99%

Idiopathic Scrotal Hematoma in Neonate: A Case Report and Review of the Literature

Jimoh¹,

Chinwe²,

Adebisi³

et al. 2014

Case Reports in Urology

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Neonatal scrotal hematoma is a rare genitourinary emergency. Some cases have underlining aetiologic factors such as testicular torsion, adrenal hemorrhage, or birth trauma, and others are idiopathic. Previously, immediate scrotal exploration was considered imperative for diagnosis and treatment. With good imaging techniques, some patients are managed nonoperatively. We report a case of idiopathic scrotal hematoma in a neonate. He was managed conservatively with clinical and radiological follow-up. There was complete resolution of hematoma within two months, thus, avoiding unnecessary exploration.

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“…Predisposing factors include prematurity, prolonged labour, a difficult delivery, macrosomia, perinatal hypoxia, coagulation disorders and septicaemia, though in most cases the aetiology cannot be established [3]. Neonatal adrenal haemorrhage (NAH) can occur in utero, but it usually appears perinatally; 5-10% of the cases involve bilateral haemorrhage; interestingly, in the unilateral cases, right adrenal gland involvement has been reported more frequently [4]. The clinical features are variable: anaemia, persistent indirect hyperbilirubinaemia, abdominal distension with an abdominal mass, and a bluish discolouration of the scrotum [5].…”

Section: Introductionmentioning

confidence: 99%

Adrenal haemorrhage in term neonates: a retrospective study from the period 2001–2013

Gyurkovits¹,

Maróti

Rénes³

et al. 2014

The Journal of Maternal-Fetal & Neonatal Medicine

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Objective: To assess the incidence, risk factors and clinical presentations of neonatal adrenal haemorrhage (NAH) in uncomplicated, singleton and term deliveries. Methods: A retrospective analysis of 26 416 term neonates delivered between 2001 and 2013, and screened with abdominal ultrasonography. Results: Of the 26 416 neonates, 74 (0.28%) displayed NAH; the male/female ratio was 1.55:1. Vaginal delivery was significantly more frequent than caesarean section among them (71 versus 3; 95.9% versus 4.1%). Unilateral bleeding occurred on the right side in 36 (48.7%), and on the left in 34 (45.9%), without a significant difference; bilateral haematomas were found in four cases (5.4%). The most common risk factors were macrosomia (16, 21.6%) and fetal acidaemia (23, 31%), while four (5.4%) neonates exhibited pathological acidaemia. Clinical presentations included jaundice in 37 (50%), anaemia in six (8.1%) and an adrenal insufficiency in only one (1.3%) case. In three cases, neuroblastoma was diagnosed. Conclusions: Vaginal delivery, macrosomia and fetal acidaemia are the most important risk factors for NAH. The adrenal glands on both sides were similarly involved. In the healthy neonates with NAH, the clinical presentations were mild, with spontaneous regression. Differentiation of NAH from tumours is of considerable importance.

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Neonatal Adrenal Hemorrhage Associated with Scrotal Hematoma: An Unusual Case Report and Literature Review

Cited by 25 publications

References 22 publications

Idiopathic scrotal hematoma simulating a testicular torsion, in association with cryptorchidism: US findings

Idiopathic scrotal hematoma simulating a testicular torsion, in association with cryptorchidism: US findings

Idiopathic Scrotal Hematoma in Neonate: A Case Report and Review of the Literature

Adrenal haemorrhage in term neonates: a retrospective study from the period 2001–2013

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