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Pham A, Biswas S, Levy A, Spiliopoulos M, McLaren R, Makhamreh MM, Al-Kouatly HB. Imaging and outcomes of fetal adrenal hemorrhage: A systematic review. Prenat Diagn 2023; 43:1433-1441. [PMID: 37786937 DOI: 10.1002/pd.6442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 08/16/2023] [Accepted: 09/10/2023] [Indexed: 10/04/2023]
Abstract
OBJECTIVE To describe prenatal and postnatal imaging findings of fetal adrenal hemorrhage (FAH) and its associated perinatal outcomes, including frequency of postnatal surgical intervention. METHOD A systematic literature review of seven electronic databases was conducted from inception until January 2022, with 2008 articles identified reporting prenatally identified fetal adrenal masses. Studies with confirmed FAH diagnosis were included. Quality and risk assessment were evaluated. RESULTS Thirty-five studies, including 102 FAH cases, were analyzed. FAH was commonly described as cystic (28/90, 31%), anechoic (25/90, 28%), or mixed echogenic (14/90, 16%) on ultrasound. Outcome data were available for 65 cases (64%) of FAH: 9% (6/65) resolved prenatally, 35% (23/65) resolved postnatally, 34% (22/65) regressed in size after birth, and 22% (14/65) persisted postnatally. Overall, 25% (16/65) of cases underwent postnatal surgical intervention. Neuroblastoma was suspected in all 16 surgical cases. Only one case (1/16, 6%) confirmed a cystic hematoma with microscopic islets of neuroblastoma in situ on pathology. CONCLUSION Prenatal diagnosis of FAH is challenging due to the significant heterogeneity of ultrasound findings. Final pathology did not support the need for surgical intervention. Persistent postnatal FAH warrants shared decision making for further management based on the clinical presentation.
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Affiliation(s)
- Amelie Pham
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Sonia Biswas
- Department of Obstetrics and Gynecology, Monmouth Medical Center, Long Branch, New Jersy, USA
| | - Ariel Levy
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Weill Cornell Medicine at New York Presbyterian Hospital, New York, New York, USA
| | - Michail Spiliopoulos
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of Miami, Miami, Florida, USA
| | - Rodney McLaren
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Jefferson University, Philadelphia, Pennsylvania, USA
| | - Mona M Makhamreh
- Department of Obstetrics and Gynecology, Maimonides Medical Center, Brooklyn, New York, USA
| | - Huda B Al-Kouatly
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Jefferson University, Philadelphia, Pennsylvania, USA
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Schwab ME, Braun HJ, Padilla BE. Imaging modalities and management of prenatally diagnosed suprarenal masses: an updated literature review and the experience at a high volume Fetal Treatment Center. J Matern Fetal Neonatal Med 2022; 35:308-315. [PMID: 31984817 PMCID: PMC9125789 DOI: 10.1080/14767058.2020.1716719] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2019] [Revised: 12/20/2019] [Accepted: 01/13/2020] [Indexed: 10/25/2022]
Abstract
BACKGROUND/PURPOSE The differential diagnosis for prenatal suprarenal masses (SRMs) is broad and includes neuroblastoma, adrenal hemorrhage, and subdiaphragmatic extralobar pulmonary sequestration (SEPS). We sought to elucidate the appropriate postnatal management for fetuses found to have an SRM. METHODS We conducted a retrospective review of patients prenatally diagnosed with SRM at our institution between 1998 and 2018. Prenatal characteristics, imaging, and neonatal outcomes were collected. We also performed a PubMed literature search and pooled analysis of all patients with a prenatally diagnosed SRM previously described in the literature. RESULTS The literature review yielded 32 studies, of which 19 were single case reports. In our case series, 12 patients were included. Seven patients were delivered vaginally, one was terminated. Postnatal diagnoses included: SEPS (n = 5), adrenal hemorrhage (n = 3), polycystic kidney (n = 2), splenic cyst (n = 1), and unknown for one patient. All but two of the final diagnoses had been on the initial diagnostic differential. With the exception of the terminated fetus, all remain alive today. On pooled analysis, patients who underwent operative management were diagnosed later 32 versus 24 weeks and had a significant predominance of left-sided lesions (59.5 versus 39.2%). The published literature demonstrates a trend toward observation versus resection over the past 30 years. CONCLUSIONS Patients prenatally diagnosed with an SRM have an excellent prognosis. Our series demonstrates a high incidence of SEPS, which were all resected, and adrenal hemorrhage, which were observed with repeat imaging. These patients can be followed with serial postnatal ultrasounds to determine the diagnosis prior to deciding the appropriate treatment.
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Affiliation(s)
- Marisa E. Schwab
- Department of Surgery, University of California, San Francisco, CA
| | - Hillary J. Braun
- Department of Surgery, University of California, San Francisco, CA
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Castro P, Paula Matos A, Werner H, Fazecas T, Nogueira R, Daltro P, Araujo Júnior E. Prenatal diagnosis of suprarenal mass by magnetic resonance imaging: a case series. J Matern Fetal Neonatal Med 2018; 32:3882-3886. [PMID: 29712514 DOI: 10.1080/14767058.2018.1471679] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Objective: The aim of this study was to evaluate the perinatal outcomes and postnatal follow-up of prenatally diagnosed suprarenal masses (SRMs) evaluated by magnetic resonance imaging (MRI). Methods: Thirteen fetuses with SRMs detected during routine prenatal ultrasound screening were evaluated by MRI between February 2007 and May 2015. The prenatal characteristics of the masses, complications of the pregnancies, and related malformations were collected as the postnatal clinical, radiological, and pathological data. Results: The median gestational age at MRI was 30 weeks (18-41), and birth weight was 3285 (1700-3750) g. The mean follow-up period was 6 years (1.3-10). We observed 69.2% of the masses, which were predominantly cystic (69.2%), located on the left side. Associated malformations were found in 23% of the fetuses, with congenital heart defects being more prevalent. During the pregnancy, 15.4% of the fetuses had involution of the SRM, and one fetus had surgical treatment and different ultrasound and MRI diagnoses. Of the 69.2% of the cases, spontaneous resolution occurred in 30.7% during the first year of life and 38.4% the masses presented without modifications or signs of regression since the neonatal period. Conclusions: Prenatal SRMs were associated with congenital heart defects. Spontaneous regression and absence of modifications in the masses were commonly observed in the long-term follow-up of the SRMs.
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Affiliation(s)
- Pedro Castro
- a Department of Radiology , Clínica de Diagnóstico por Imagem (CDPI) , Rio de Janeiro , Brazil
| | - Ana Paula Matos
- a Department of Radiology , Clínica de Diagnóstico por Imagem (CDPI) , Rio de Janeiro , Brazil
| | - Heron Werner
- a Department of Radiology , Clínica de Diagnóstico por Imagem (CDPI) , Rio de Janeiro , Brazil
| | - Tatiana Fazecas
- a Department of Radiology , Clínica de Diagnóstico por Imagem (CDPI) , Rio de Janeiro , Brazil
| | - Renata Nogueira
- a Department of Radiology , Clínica de Diagnóstico por Imagem (CDPI) , Rio de Janeiro , Brazil
| | - Pedro Daltro
- a Department of Radiology , Clínica de Diagnóstico por Imagem (CDPI) , Rio de Janeiro , Brazil
| | - Edward Araujo Júnior
- b Department of Obstetrics, Paulista School of Medicine , Federal University of São Paulo (EPM-UNIFESP) , São Paulo , Brazil
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Özsürmeli M, Büyükkurt S, Özden Ö, Sucu M, Çetin C, Tuncay Özgünen F. What is your diagnosis? J Turk Ger Gynecol Assoc 2017; 18:60-61. [PMID: 28506953 PMCID: PMC5450213 DOI: 10.4274/jtgga.2016.0220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Affiliation(s)
- Mehmet Özsürmeli
- Department of Obstetrics and Gynecology, University of Çukurova, School of Medicine, Adana, Turkey
| | - Selim Büyükkurt
- Department of Obstetrics and Gynecology, University of Çukurova, School of Medicine, Adana, Turkey
| | - Önder Özden
- Department of Pediatric Surgery, University of Çukurova, School of Medicine, Adana, Turkey
| | - Mete Sucu
- Department of Obstetrics and Gynecology, University of Çukurova, School of Medicine, Adana, Turkey
| | - Cihan Çetin
- Department of Obstetrics and Gynecology, Derince Training and Research Hospital, Kocaeli, Turkey
| | - Fatma Tuncay Özgünen
- Department of Obstetrics and Gynecology, University of Çukurova, School of Medicine, Adana, Turkey
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CARSOTE MARA, GHEMIGIAN ADINA, TERZEA DANA, GHEORGHISAN-GALATEANU ANCUTAAUGUSTINA, VALEA ANA. Cystic adrenal lesions: focus on pediatric population (a review). CLUJUL MEDICAL (1957) 2017; 90:5-12. [PMID: 28246490 PMCID: PMC5305088 DOI: 10.15386/cjmed-677] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Revised: 05/18/2016] [Accepted: 05/26/2016] [Indexed: 12/25/2022]
Abstract
BACKGROUND AND AIM The cysts may potentially affect any organ; adrenals cysts are rare. This is a review of the literature regarding adrenal cysts, focusing on children and young adults. GENERAL DATA Three major types have been described: pure cysts (endothelial, epithelial, and hemorrhagic or pseudocyst), parasitic (as hydatid) cysts and cystic part of a tumour (most frequent are neuroblastoma, ganglioneuroma, pheocromocytoma, and teratoma). The complications are: bleeding, local pressure effects; infection; rupture (including post-traumatic); arterial hypertension due to renal vessels compression. Adrenal hemorrhage represents a particular condition associating precipitating factors such as: coagulation defects as Factor IX or X deficiency, von Willebrand disease, thrombocytopenia; antiphospholipid syndrome; previous therapy with clopidogrel or corticosteroids; the rupture of a prior tumour. At birth, the most suggestive features are abdominal palpable mass, anemia, and persistent jaundice. Adrenal insufficiency may be found especially in premature delivery. The hemorrhage is mostly self-limiting. Antenatal ultrasound diagnosis of a cyst does not always predict the exact pathology result. The most important differential diagnosis of adrenal hemorrhage/hemorrhagic cyst is cystic neuroblastoma which is highly suggestive in the presence of distant metastases and abnormal catecholamine profile. The major clue to differentiate the two conditions is the fact that the tumor is stable or increases over time while the adrenal hemorrhage is expected to remit within one to two weeks. CONCLUSION Pediatric adrenal cysts vary from simple cysts with a benign behavior to neoplasia- related lesions displaying severe prognosis as seen in cystic neuroblastoma. A multidisciplinary team is required for their management which is conservative as close follow-up or it makes necessary different surgical procedures in cases with large masses or if a malignancy suspicion is presented. Recently, laparoscopic approach is regarded as a safe procedure by some authors but generally, open surgery is more frequent used compare to adults; in most cases the preservation of normal gland is advisable.
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Affiliation(s)
- MARA CARSOTE
- Endocrinology Department, Carol Davila University of Medicine and Pharmacy & C.I. Parhon National Institute of Endocrinology, Bucharest, Romania
| | - ADINA GHEMIGIAN
- Endocrinology Department, Carol Davila University of Medicine and Pharmacy & C.I. Parhon National Institute of Endocrinology, Bucharest, Romania
| | - DANA TERZEA
- Endocrinology Department, Monza Oncoteam Hospital & C.I. Parhon National Institute of Endocrinology, Bucharest, Romania
| | | | - ANA VALEA
- Endocrinology Department, Iuliu Hatieganu University of Medicine and Pharmacy & Clinical County Hospital, Cluj-Napoca, Romania
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Kütük MS, Doğanay S, Özdemir A, Görkem SB, Öztürk A. Sonographic Diagnosis of Fetal Adrenal Hemorrhage Complicating a Vein of Galen Aneurysmal Malformation. Balkan Med J 2016; 33:112-4. [PMID: 26966627 DOI: 10.5152/balkanmedj.2015.151118] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2014] [Accepted: 07/10/2015] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND The vein of Galen aneurysmal malformation (VGAM) is a rare intracranial vascular malformation which causes end-organ ischemia or venous congestion due to heart failure. Adrenal hemorrhage associated with VGAM has not been reported in the literature. We present the imaging findings of a fetal VGAM with adrenal hemorrhage. CASE REPORT A 26 year-old primigravida woman whose fetus with VGAM and mild cardiomegaly was scanned in the 34th week. On fetal ultrasound, a hyperechoic, well-circumscribed mass in the left suprarenal region was shown. Fetal and postnatal magnetic resonance imaging confirmed the diagnosis of adrenal hemorrhage. The baby died after delivery. CONCLUSION Adrenal hemorrhage can complicate VGAM in fetuses with severe heart failure. Evaluation of the adrenal gland in affected cases may contribute to the prenatal counseling, and postnatal management.
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Affiliation(s)
- Mehmet Serdar Kütük
- Department of Obstetrics and Gynecology, Erciyes University Faculty of Medicine, Kayseri, Turkey
| | - Selim Doğanay
- Department of Radiology, Division of Pediatric Radiology, Erciyes University Faculty of Medicine, Kayseri, Turkey
| | - Ahmet Özdemir
- Department of Pediatrics, Division of Neonatalogy, Erciyes University Faculty of Medicine, Kayseri, Turkey
| | - Süreyya Burcu Görkem
- Department of Radiology, Division of Pediatric Radiology, Erciyes University Faculty of Medicine, Kayseri, Turkey
| | - Adnan Öztürk
- Department of Pediatrics, Division of Neonatalogy, Erciyes University Faculty of Medicine, Kayseri, Turkey
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Postnatal sonographic spectrum of prenatally detected abdominal and pelvic cysts. AJR Am J Roentgenol 2015; 203:W684-96. [PMID: 25415735 DOI: 10.2214/ajr.13.12371] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVE The purpose of this article is to illustrate the sonographic findings of a spectrum of neonatal abdominal and pelvic cystic lesions. CONCLUSION Neonatal abdominal and pelvic cystic lesions can arise from many organs, and they have a broad differential diagnosis. Distinctive sonographic findings may be present and can help establish the correct cause and guide proper management.
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Prenatal diagnosis of adrenal neuroblastoma: a case report with a brief review of the literature. Case Rep Obstet Gynecol 2013; 2013:506490. [PMID: 23607014 PMCID: PMC3623461 DOI: 10.1155/2013/506490] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2013] [Accepted: 03/12/2013] [Indexed: 11/18/2022] Open
Abstract
A case of adrenal cystic neuroblastoma detected at 37 weeks of gestation is reported. Postnatal ultrasonographic examination showed slightly increased in size demonstrating marked septations within the cyst. After the tumor was resected, histopathological examinations confirmed the diagnosis. The patient is developing normally at 1 year of age.
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Valdespino RS. The Importance of Sonography in the Evaluation of Neonatal Adrenal Hemorrhage. JOURNAL OF DIAGNOSTIC MEDICAL SONOGRAPHY 2009. [DOI: 10.1177/8756479309338954] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Neonatal adrenal hemorrhage is a relatively common condition of the newborn. Etiologies of neonatal adrenal hemorrhage include maternal/ fetal stress, birth trauma, congenital syphilis, dehydration, anoxia, or other systemic disorders. Clinical presentation ranges from asymptomatic to anemia, hypotension, vomiting, jaundice/hyperbilirubinemia, scrotal discoloration, hyponatremia, and palpable abdominal mass. Adrenal hemorrhage sonographically appears as an abdominal mass with displacement of the kidney inferiorly, known as mass effect. Differentiation of adrenal hemorrhage from more serious pathologies such as adrenal carcinoma, neuroblastoma, or pheochromocytoma is critical. Bluish discoloration of the scrotum may also occur due to extravasation of blood from the hemorrhage, leading to an incorrect diagnosis of testicular torsion or acute scrotum. Proper sonographic evaluation conservatively avoids unnecessary surgical exploration. Power Doppler imaging, color Doppler imaging, and serial gray-scale sonography can document the characteristics and progression of the condition for accurate diagnosis. Sonography is a preferred noninvasive screening modality for evaluating abdominal masses within the pediatric population because of its sensitivity, avoidance of radiation and sedation, and potential value for avoiding exploratory surgery.
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Affiliation(s)
- Rini-Sultana Valdespino
- Orange Coast College, School of Allied Health Professions, Diagnostic Medical Sonography Division, Costa Mesa, California, , University of California at Irvine Medical Center, Department of Radiology, Ultrasound Division, Orange, California, Kaiser Permanente Riverside Medical Center, Department of Radiology, Ultrasound Division, Riverside, California
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Abstract
A prenatally detected suprarenal cystic mass measuring 2 cm was found to have enlarged upon postnatal ultrasonography at 6 weeks of age. Magnetic resonance imaging showed a 57 x 50 mm mass in the left adrenal region displacing the kidney inferiorly. The infant underwent an adrenalectomy with total resection of the tumor, which proved on histologic examination to be a mature teratoma. Prenatally detected suprarenal masses are likely to be neuroblastoma or adrenal hemorrhage, but may be rare benign lesions such as extralobar pulmonary sequestration, bronchogenic cyst, or renal dysplasia. Although teratoma in the adrenal region is extremely rare, it should be included in the clinical and radiologic differential diagnosis of prenatally detected suprarenal masses. Total excision of the mass for histologic diagnosis is indicated.
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