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A neonate presented with anemia, hyperbilirubinemia and bilateral flank fullness at 23 days of age. Ultrasound abdomen showed bilateral adrenal hemorrhage with intraperitoneal extension on the left side. This was managed nonoperatively and the hematoma resolved completely. Literature regarding this rare entity is described.
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Antiplatelet autoantibodies in women with autoimmune thrombocytopenic purpura can cause fetal thrombocytopenia and serious bleeding problems. Obstetricians have used fetal scalp sampling, cordocentesis, and cesarean delivery in this disorder to avoid fetal complications such as intracranial hemorrhage. Accumulating evidence indicates that the fetal risk of intracranial hemorrhage is much lower than initially reported. Moreover, these invasive tests and treatments are costly, cause morbidity, and have little effect in preventing neonatal bleeding complications. Therefore we suggest these interventions should no longer be used in the management of maternal thrombocytopenia.
At 35 weeks 6 days of gestational age, ultrasound evaluation of the fetal abdomen showed a mixed cystic mass in the superior pole of the left kidney. The mass was suspected to be an adrenal hemorrhage or neuroblastoma. The diagnosis was fetal neuroblastoma. Differential diagnosis enabled the fetal neuroblastoma to be distinguished from adrenal hemorrhage. The parameters of diagnosis of fetal neuroblastoma include no specific ultrasonographic pattern, lack of palpability, and no tumor markers. However, certain features do characterize fetal neuroblastoma, such as little metastases, complete resection at operation, and excellent prognosis. In cases of suspected neuroblastoma, a laparotomy performed as soon as possible is generally regarded as the best course of treatment. Nonetheless, biological analyses of the tumor may prove in the future to be necessary for determining whether or not laparotomy is the best treatment.
Exposure conditions were determined for hind limb paralysis and lung hemorrhage of neonatal mice due to pulsed exposure (10 microsecond pulse duration) to 1 MHz focused ultrasound. Spatial peak pulse average intensity and peak rarefactional pressure levels for paralysis in 50% of specimens sonicated were determined for pulse repetition frequencies of 1, 5 and 50 kHz at 10 degrees C and 2.4 s exposure duration. The results suggest that cavitation was involved in the paralysis at a pulse repetition frequency (PRF) of 50 kHz, but that cavitation took place in the coupling medium and probably not within the specimen during exposures at a PRF of 5 kHz. The results show an inverse relation between spatial peak pulse average intensity, or peak rarefactional pressure and sound on-time. Exposure conditions for lung hemorrhage were determined for a pulse duration of 10 microseconds at 10 degrees C and exposure durations of 2.4 and 180 s. The results show that the threshold exposure conditions for lung hemorrhage are much less than the conditions for cavitational or other effects reported for tissues that do not contain well defined gas bodies. In addition, the results show an inverse relation between exposure level and either exposure duration or sound on-time, suggesting that time is an important parameter associated with bubble effects.
In three fetuses, congenital intestinal atresia was associated with linear ulcerations of the umbilical cord. In two cases, hemorrhage was seen from the cord ulcer. Both fetuses required emergency cesarean section for fetal distress and were born anemic. The third fetus was mildly hydropic, attributed to hemorrhage, and was stillborn. The mechanism of the association could not be determined. These cases suggest a risk of prenatal umbilical cord hemorrhage in infants with intestinal atresia.
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Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Aortopulmonary collateral arteries sometimes complicate cyanotic congenital heart defects. Combined with a relevant left-right shunt, this could result in massive airway bleeding during and after corrective surgery. A preoperatively diagnosed 1.2 mm small aortopulmonary collateral artery in a newborn suffering from transposition of the great arteries caused life-threatening airway bleeding during surgery. Postoperative extracorporeal membrane oxygenation (ECMO) was necessary, and coil embolization was performed on ECMO to terminate pulmonary bleeding.
We present a rare occurrence of an early-onset extensive cystic hygroma colli with intralesional hemorrhage and a favorable outcome. A 23-year-old primigravida woman was referred for management of a left isolated extensive cystic hygroma colli at 22 weeks' gestation. Amniocentesis revealed a 46, XY karyotype. Ultrasound-guidance in utero paracentesis was performed weekly or fortnightly from 22 to 36 gestational weeks. The aspirated fluid was chocolate-colored and contained abundant lymphocytes, erythrocytes, and protein. Despite multiple aspirations, the fetal cystic hygroma colli increased in size from 5.2x4.2 cm at 22 weeks' gestation to 9x9.7 cm at 36 weeks' gestation. The woman underwent cesarean section at 36 week's gestation and a-2808 g neonate was born with a 10x6 cm left neck mass, which did not impair spontaneous normal respiration. At the age of 4 days, the neonate underwent simple excision of the cystic hygroma, which was confined to the anterior superficial neck. The neonate was discharged 4 days after operation in good condition. In the present case, in utero paracentesis did not prevent the progressive growth of an early-onset extensive cystic hygroma colli with intralesional hemorrhage. However, lack of extension of the lesion into the surrounding structures and successful postnatal surgery contributed to the favorable outcome of this patient.
UNLABELLED: The influence of genetic factors that increase coagulation on the extension of intraventricular haemorrhage (IVH) in very low birthweight infants has not been studied previously. This study investigated the frequency and effect of the factor V Leiden and prothrombin G20210A mutations in a population-based cohort of 305 preterm infants with a birthweight below 1500 g. The overall prevalence of IVH was similar in infants with (n = 43) and without (n = 262) prothrombotic mutations (18.6% vs 16.4%, respectively). However, infants with prothrombotic mutations had a significantly reduced risk of developing extension to IVH grade II or more [p = 0.023, odds ratio (OR) 0.11, 95% confidence interval (CI) 0.02-0.5]. The carrier state of a factor V Leiden or prothrombin G20210A mutation was still predictive for a low rate of IVH grade II-IV if possible confounding variables were included in a multivariate regression model (OR 0.12; 95%CI: 0.017-0.86). CONCLUSION: The data suggest that the factor V Leiden and prothrombin G20210A mutations lead to improved control of intraventricular bleeding in very low birthweight infants.
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A rare case of simultaneous renal vein thrombosis and bilateral adrenal hemorrhage is presented, showing the utility of Tc-99m DTPA and DMSA renal scans to identify the condition and to assess renal function. The characteristic appearances of suprarenal tracer-free areas encircled by peripheral radioactive rims over the inferiorly displaced kidneys on a Tc-99m DTPA renal scan, and that of the flattened upper poles of the kidneys on a Tc-99m DMSA scan, were pathognomonic and strongly indicative of bilateral adrenal hemorrhage. These two scans also showed markedly diminished tracer uptake in the poorly functioning right thrombosed kidney. Follow-up imaging using these two renal scans well demonstrated the functional and morphologic alterations and recovery of the kidneys.
A case of simultaneous renal vein thrombosis and bilateral adrenal hemorrhage is presented, demonstrating the ability of magnetic resonance (MR) imaging to identify these abnormalities without the use of intravenous contrast agents or radiopharmaceuticals. Adrenal hemorrhage appeared as markedly enlarged adrenal glands with homogeneous high signal intensity on both T1 and T2 weighted spin echo MR images. The kidney involved with renal vein thrombosis was enlarged and demonstrated increased signal from the renal parenchyma on T2 weighted images.