Neonatal adrenal hemorrhage presenting as “Acute Scrotum”-looking beyond the obvious: a sonographic insight

Abstract

Acute swelling and discoloration of scrotum in new born can have many localized causes like testicular torsion, inguinal hernia, scrotal or testicular edema, hydrocele, or even remote causes like adrenal hemorrhage. We report a neonate of adrenal hemorrhage presenting clinically as acute scrotum misguiding the clinician to rule out a local scrotal pathology. As the local clinical examination is not reliable in a newborn, it definitely requires an imaging evaluation to establish the diagnosis. This case report emphasizes being aware of the clinical association of acute adrenal hemorrhage and an acute scrotum and the role of ultrasonography in the evaluation of the various differential diagnoses leading to an acute scrotum. An optimum sonographic examination helps in suspecting an abdominal pathology as a cause of acute scrotum and in establishing the specific diagnosis of adrenal hemorrhage to avoid an unnecessary surgical exploration.

Sommario

La tumefazione acuta con pallore dello scroto nel neonato può avere molteplici cause come la torsione testicolare, l’ernia inguinale, l’edema scrotale o testicolare, l’idrocele e anche cause remote come l’emorragia surrenalica. Riportiamo il caso di emorragia surrenalica di un neonato che si presenta clinicamente come scroto acuto, portando il medico al dubbio di una patologia scrotale locale. Poiché l’esame clinico nel neonato è difficile, si richiede necessariamente una valutazione di imaging per formulare la diagnosi. Il caso riportato vuole sottolineare la possibilità di una associazione di emorragia surrenalica acuta con scroto acuto, nonché il ruolo dell’ecografia nella valutazione delle varie diagnosi differenziali dello scroto acuto. Un esame ecografico ottimale aiuta nell’identificare il sospetto di patologia addominale come causa di scroto acuto e a stabilire la diagnosi specifica dell’emorragia surrenalica al fine di evitare un’inutile esplorazione chirurgica.

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Correspondence to Shuchi Bhatt.

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This case report complies with the ethical standards laid down in the Helsinki Declaration of 1975 and its late amendments. The confidentiality of the patient has been maintained. The manuscript has been read and approved by all the authors and all have significantly contributed towards the article.

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The written informed consent had been obtained from the patient’s parents for publication of the case details and the images as well.

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Bhatt, S., Ahmad, M., Batra, P. et al. Neonatal adrenal hemorrhage presenting as “Acute Scrotum”-looking beyond the obvious: a sonographic insight. J Ultrasound 20, 253–259 (2017). https://doi.org/10.1007/s40477-017-0248-3

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Keywords

  • Adrenal hemorrhage
  • Ultrasonography
  • Acute scrotum