Neonatal adrenal hemorrhage presenting as “Acute Scrotum”-looking beyond the obvious: a sonographic insight

Abstract

Acute swelling and discoloration of scrotum in new born can have many localized causes like testicular torsion, inguinal hernia, scrotal or testicular edema, hydrocele, or even remote causes like adrenal hemorrhage. We report a neonate of adrenal hemorrhage presenting clinically as acute scrotum misguiding the clinician to rule out a local scrotal pathology. As the local clinical examination is not reliable in a newborn, it definitely requires an imaging evaluation to establish the diagnosis. This case report emphasizes being aware of the clinical association of acute adrenal hemorrhage and an acute scrotum and the role of ultrasonography in the evaluation of the various differential diagnoses leading to an acute scrotum. An optimum sonographic examination helps in suspecting an abdominal pathology as a cause of acute scrotum and in establishing the specific diagnosis of adrenal hemorrhage to avoid an unnecessary surgical exploration.

Antenatal Idiopathic Scrotal Haematoma: A Case Report

“…Various causes of scrotal haematoma have been described in literature such as adrenal haemorrhage, scrotal trauma, postsurgical, coagulopathy, or idiopathic etc. [2][3][4] In the index case, we could not find any obvious sign of haemorrhage in abdomen. Only minimal fluid accumulation in peri-hepatic (confined to sub-diaphragmatic region) and peri-splenic region was observed.…”

“…Few neonatal cases of visceral bleeding presenting as scrotal haematoma have been reported in literature. [4][5][6]We can speculate that adrenal or some visceral haemorrhage occurring before 28 weeks of gestation might have extended to scrotum and resolved with no sonographical features; or it could be idiopathic in etiology. Extensive work-up including MRI or CT scan imaging can point to the diagnosis.…”

Bilateral Adrenal Hemorrhage in a 6-Day-Old Neonate Presenting with Hematuria of 2 Days Duration: Case Report

“… 3 Additionally, anemia, unexplained jaundice, hematuria, or scrotal hematoma or swelling may be the presenting sign. 2 , 4 , 6 Laboratory findings include anemia, hyponatremia, hyperkalemia, hypoglycemia, hypocortisolemia, eosinophilia, leukocytosis, hematuria, proteinuria, elevated adrenocorticotropic hormone, and elevated renin activity. 2 , 4 In our case, apart from hematuria, there was no other symptom.…”

Neonatal Adrenal Hemorrhage: A Case Series

“…The central portion of the adrenal hemorrhage usually becomes less echogenic, giving a pseudocystic image that appears as a mass with hypoechoic center and may or may not have inner calcifications, these last usually developing in 1 to 2 weeks from the onset of the hemorrhage. 7 When an NAH is found, the kidneys must be scanned and measured and the echogenicity evaluated for renal vein thrombosis. NAH is usually self-limiting and prone to a progressive resolution, since the adrenal gland has a considerable regenerative capacity, with lesions fully disappearing in a time usually comprised between three weeks and 6 months, 3 as described in the reported cases.…”