Diagnosis of fetal adrenal hematoma through prenatal ultrasound: a case report and literature review
10.3760/cma.j.cn113903-20230723-00029
- VernacularTitle:产前超声诊断胎儿肾上腺血肿1例并文献复习
- Author:
Xuyu HE
1
;
Xiaohua LI
;
Sen MAO
;
Wenjing SHI
Author Information
1. 济宁医学院临床医学院，济宁 272013
- Keywords:
Adrenal gland diseases;
Hematoma;
Ultrasonography, prenatal;
Diagnosis, differential;
Adrenal gland neoplasms;
Neuroblastoma
- From:
Chinese Journal of Perinatal Medicine
2024;27(2):148-153
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To investigate the ultrasonic characteristics and evolution pattern of fetal adrenal hematoma (AH).Methods:A retrospective analysis was conducted on the clinical data of one fetal AH diagnosed at the Affiliated Hospital of Jining Medical University. The study involved a comprehensive search of the relevant cases of fetal AH published from January 1, 1989, to December 31, 2022, in the Yiigle database, China National Knowledge Infrastructure Database, Wanfang Database, and PubMed Database. The clinical features, sonographic characteristics, interventions, and prognosis of fetal AH were summarized. Descriptive statistical analysis was used.Results:(1) Case: An ultrasound at 36 +3 weeks of pregnancy detected a mixed echogenic nodule at the fetal left adrenal region, with clear border and no obvious blood flow signal. Fetal AH was considered. Observations from the close ultrasound follow-up on the case before and after birth, and one year and eight months after birth presented a gradual transformation of the lesion from mixed echogenic to solid echogenic and a reduction following enlargement in lesion size. The lesion was ultimately liquefied and absorbed. (2) Literature review: A total of 12 cases of fetal AH that had clear diagnosis and ultrasound data were retrieved and added to the present case, for a total of 13 cases. Neither prenatal maternal nor postnatal typical clinical manifestations were observed in fetal AH cases. In cases with large hemorrhage and/or bilateral adrenal hemorrhage, mild jaundice and feeding difficulties may be present. Two cases were terminated, one live baby died of heart failure due to vein of Galen aneurysmal malformation, other ten had good prognosis. Fetal AH ultrasound image features demonstrated time-dependent changes, progressing in the sequence of anechoicity, solid echogenicity, mixed echogenicity, and complete absorption of the lesion, or residual hyperechogenicity. Conclusions:Fetal AH is a rare condition that exhibits characteristic transformations in ultrasound image features over time. Conducting close follow-up ultrasound examinations is the preferred and crucial approach to the diagnosis of fetal AH.
