Acute scrotal swelling: a sign of neonatal adrenal haemorrhage

Neonatal adrenal hemorrhage associated with scrotal hematoma: an unusual case report and literature review

Neonatal adrenal hemorrhage (NAH) is rare and is found in only 0.2% of newborns. Scrotal hematoma (SH) in newborns is also rare. NAH associated with SH is extremely rare, with only 29 cases reported in the literature. Herein, we report a baby boy who presented with SH; after ultrasonography examinations, the diagnosis of NAH associated with SH was made. He received conservative treatment only. From our experience and that of others, appropriate integration of clinical information, physical examination and the results of abdominal and scrotal ultrasonography can achieve the accurate diagnosis of NAH associated with SH. This association allows conservative treatment that avoids unnecessary surgical exploration.

Scrotal hematoma as a sign of adrenal hemorrhage in newborns

CONTEXT

Bluish discoloration and swelling of the scrotum in newborns can arise from a number of diseases, including torsion of the testes, orchitis, scrotal or testicular edema, hydrocele, inguinal hernia, meconium peritonitis, hematocele, testicular tumor and traumatic hematoma. Forty-two cases of scrotal abnormalities as signs of neonatal adrenal hemorrhage were found in the literature.

CASE REPORT

We present a case of scrotal hematoma due to adrenal hemorrhage in a newborn. Conservative treatment with clinical follow-up was adopted, with complete resolution within 10 days. The possible differential diagnoses are reviewed and discussed.

Neonatal adrenal hemorrhage mimicking an acute scrotum

Twenty-two cases of scrotal hematoma caused by neonatal adrenal hemorrhage are reported in the literature and unnecessary surgical exploration was performed in nine (41%), suspecting testicular torsion. In this paper, we present a newborn male with right adrenal gland hemorrhage causing right scrotal swelling and discoloration of groin managed conservatively.

Neonatal scrotal haematoma: mimicker of neonatal testicular torsion

OBJECTIVE

To describe the clinical features of neonatal scrotal haematoma and distinguish them from those of neonatal testicular torsion.

PATIENTS AND METHODS

Five neonates presenting with an acute scrotum and initial diagnosis of neonatal testicular torsion were found to have neonatal scrotal haematoma. In one case the diagnosis was surgical and in four subsequent cases the diagnosis was by colour Doppler ultrasonography, and surgery was avoided. Four of the five children had risk factors associated with neonatal scrotal haematoma, including bleeding diathesis, birth trauma and high birth weight.

CONCLUSIONS

The importance of including haematoma in the differential diagnosis of the acute neonatal scrotum is emphasized, as is the value of contemporary Doppler ultrasonography in making this diagnosis.

Neonatal adrenal hemorrhage manifesting as acute scrotum: timely diagnosis prevents unnecessary surgery

Neonatal adrenal hemorrhage presenting as scrotal swelling has been reported in 17 cases, with unnecessary surgical exploration in 7. We report 2 new cases, emphasizing the knowledge of this clinical association and the role of ultrasonography in the differential diagnosis for this specific condition and in all cases of neonatal acute scrotum.

Inguinoscrotal bruising: a sign of neonatal adrenal hemorrhage

A 5-day-old baby presented with right inguinoscrotal bruising. The underlying testis and cord were normal on examination. Intra-abdominal bleeding was suspected. Abdominal ultrasound showed right adrenal hemorrhage. This was managed nonoperatively and with supportive therapy; the inguinoscrotal bruising resolved spontaneously.

Scrotal hematocele as an unusual presentation of blunt abdominal trauma in three male infants

Three infants presented with bluish discoloration and swelling of the scrotum with no history of scrotal trauma. Sonography revealed unilateral hematoceles in 2 cases and bilateral hematoceles in the third. All 3 infants had intact testes. The communicating hematoceles were the result of hemoperitoneum due to splanchnic hematoma.

Scrotal hematoma, anemia, and jaundice as manifestations of adrenal neuroblastoma in a newborn

Clinically, a neuroblastoma presents mostly as an abdominal mass. Within the tumor, bleeding can be present, sometimes extending in to its surroundings. This case report describes a neuroblastoma, presenting as scrotal hematoma in a newborn boy, which initially raised the suspicion of a torsion testis. In this patient, the bleeding descended through the subcutaneous and muscular tissue into the scrotum. In addition, anemia and jaundice were marked features. This clinical manifestation of a neuroblastoma has not been reported previously. Ultrasonography is advised as the first diagnostic step to exclude retroperitoneal origin of the bleeding. Magnetic resonance imaging and meta-iodobenzyl guanidine scanning were helpful tools in the final diagnostic workup.