Does Urinary Tract Ultrasound Have Its Place in the Treatment of Early Neonatal Jaundice? Neonatal Bilateral Adrenal Hemorrhage: Case Report

Abstract

Adrenal hemorrhage is a rare clinical entity in the neonatal period, with an incidence of 1.7-2.1/1000 births. It is more often diagnosed on the right side, whilst bilateral hemorrhage occurs in 10%-15% of cases. Clinical presentation shows a wide range of symptoms, from the signs of adrenal insufficiency to asymptomatic course of illness with incidental finding of changes on testing. Neonatal jaundice due to hemolysis of hemorrhagic content often is an accompanying sign. We present a male neonate born at term, with early neonatal jaundice of unknown cause and without evi-dence of perinatal infection. Ultrasound of the urinary tract revealed hypoechoic formations in the upper poles of both kidneys, confirmed by magnetic resonance imaging of the abdomen. Clinical and laboratory test results showed no signs of adrenal insufficiency. There was no confirmation of em-bryonic tumor or neuroblastoma. Ultrasound of the urinary tract as an available and noninvasive test has its place in the treatment of early neonatal jaundice of unknown cause. Additional invasive treat-ment and unnecessary laparotomy can be avoided with ultrasound monitoring of the formation re-gression.

Keywords: Adrenal gland diseases; Adrenal insufficiency; Hemorrhage; Infant, newborn; Jaundice, neonatal.

Fig. 1

Ultrasound showing right adrenal hematoma (seventh day of life).

Fig. 2

Ultrasound showing left adrenal hematoma (seventh day of life).

Fig. 3

Magnetic resonance image showing bilateral adrenal hemorrhage (ninth day of life).

Fig. 4

Magnetic resonance image showing bilateral adrenal hemorrhage (ninth day of life).

Fig. 5

Follow-up ultrasound 3 months later showing almost complete resolution of the hematoma.