Question 3 of 18

(demo test)

Product Demo for CORE

An infant of a diabetic mother experiences a drop in his hematocrit .  He undergoes an abdominal ultrasound (images of the right upper quadrant are provided).  What is the diagnosis?

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  Image courtesy of Terry Levin, MD
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  Image courtesy of Terry Levin, MD
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  Image courtesy of Terry Levin, MD
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  Image courtesy of Terry Levin, MD
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  Image courtesy of Terry Levin, MD
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  Image courtesy of Terry Levin, MD

A. Hydronephrosis

B. Wilms tumor

C. Hepatoblastoma

D. Adrenal hemorrhage

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Category:

Pediatric Radiology

High Yield:

No

Your Answer:

U

Correct Answer:

D

Explanation:

There is a suprarenal complex mass arising from the adrenal gland.  The diagnosis is adrenal hemorrhage.  Infants of diabetic mothers are at risk for this complication.  These should be followed to resolution. 

Rarely, a neuroblastoma may present in a newborn as an adrenal bleed.  Wilms tumor occurs in young children, not neonates, and this is extrarenal.  Similarly, this is not arising from the liver and is, therefore,  not a hepatoblastoma.  There is no hydronephrosis.  Normal echo-poor pyramids are seen in the kidney. 

REFERENCE:

Abdu AT, Kriss VM, Bada HS, Reynolds EW. Adrenal hemorrhage in a newborn. Am J Perinatol. 2009 Sep;26(8):553-7.

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  Short axis view of the normal right kidney, labeled RK.
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  Short axis view of the normal right kidney, labeled RK.
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  Short axis view superior to the right kidney, outlined by red arrows demonstrates complex right adrenal hemorrhage. Notice how the adrenal hemorrhage is separate from the liver.
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  Short axis view superior to the right kidney, outlined by red arrows demonstrates complex right adrenal hemorrhage. Notice how the adrenal hemorrhage is separate from the liver.
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  Long axis view outlined by red arrows shows right adrenal hemorrhage.
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  Long axis view outlined by red arrows shows right adrenal hemorrhage.

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