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Joseph Junewick, MD FACR
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Neonatal Adrenal Hemorrhage

Case Detail

Anatomy: Genitourinary
Joseph Junewick, MD FACR
Diagnostic Category: Developmental or Congenital
Created: over 7 years ago
Updated: over 4 years ago
Tags: PEDS
Modality/Study Types: US
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Newborn with anemia.

Case Images


Neonatal Adrenal Hemorrhage


US – Round avascular cystic mass with fluid-fluid level.


The adrenal cortex is supplied by numerous small penetrating arteries that supply medullary sinusoids but the gland is drained by relatively few venues. This vascular anatomy accompanied by the increase in vascularity during stress and/or the venoconstriction during shock makes the adrenal gland vulnerable to hemorrhage. Adrenal hemorrhage is more common in neonates than in older children or adults and is the most common adrenal mass in neonates; those with a history of perinatal distress, diabetic mothers, sepsis, renal vein thrombosis and coagulopathy are prone. Adrenal hemorrhage is more frequent on the right side (70% of cases), a phenomenon that has been attributed to compression of the adrenal gland between the liver and kidney. The adrenal gland is susceptible to hemorrhage at birth as the result of regression of the fetal cortex, which occurs rapidly during the first 6 weeks of life. Patients may present with abdominal mass, anemia, jaundice, flank/perineal discoloration. Adrenal insufficiency as a result of adrenal hemorrhage is rare in neonates.


Kawashim A, Sandler CM, Ernst RD, et al. Imaging of Nontraumatic Hemorrhage of the Adrenal Gland. Radiographics (1999); 19:949-963.

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