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Kim, Oh, Kim, Lee, Lee, Hwang, Namkung, and Bae: Neonatal Adrenal Hemorrhage Presenting as Acute Scrotum
Original Article

Korean J Urol 2007;48(7):757-760.

Published online: 20 January 2007

DOI: https://doi.org/10.4111/kju.2007.48.7.757

Neonatal Adrenal Hemorrhage Presenting as Acute Scrotum

Seyung Kim, Jae Rock Oh, Jin Bum Kim, Seong Ho Lee, Sang Kon Lee, Im Kyung Hwang1, Sook Namkung1, Eun Joo Bae2

From the Department of Urology, School of Medicine, Hallym University, Seoul, Korea

1From the Department of Radiology, School of Medicine, Hallym University, Seoul, Korea

2From the Department of Pediatrics, School of Medicine, Hallym University, Seoul, Korea

한림대학교 의과대학 춘천성심병원 비뇨기과 강원도 춘천시 교동 153번지 ? 200-704 TEL: 033-240-5161 FAX: 033-255-6244 E-mail: shleeuro@ hallym.ac.kr

Received 24 April 2007       Accepted 4 June 2007

Copyright © 2007 The Korean Urological Association

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

There has been only 23 cases of neonatal adrenal hemorrhage presenting as an acute scrotum and unnecessary surgical exploration was performed in nine of these case (39%) due to suspected testicular torsion. We report here on a case of a 2-day-old boy with neonatal adrenal hemorrhage, and he presented with an acute scrotum; this child's condition was managed conservatively.

Keywords: Neonate, Adrenal glands, Hemorrhage, Scrotum

References

1. Black J, Williams DI. Natural history of adrenal hemorrhage in the newborn. Arch Dis Child. 1973; 48:183–90.
2. Adorisio O, Mattei R, Ciardini E, Centonze N, Noccioli B. Neonatal adrenal hemorrhage mimicking an acute scrotum. J Perinatol. 2007; 27:130–2.
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3. Avolio L, Fusillo M, Ferrari G, Chiara A, Bragheri R. Neonatal adrenal hemorrhage manifesting as acute scrotum: timely diagnosis prevents unnecessary surgery. Urology. 2002; 59:601.
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4. Giacoia GP, Cravens JD. Neonatal adrenal hemorrhage presenting as scrotal hematoma. J Urol. 1990; 143:567–8.
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5. Karpe B, Nybonde T. Adrenal hemorrhage versus testicular torsion-a diagnostic dilemma in the neonate. Pediatr Surg Int. 1989; 4:337–40.
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6. Putnam MH. Neonatal adrenal hemorrhage presenting as a right scrotal mass. JAMA. 1989; 261:2958.
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7. Amoury RA, Barth GW, Hall RT, Rhodes PG, Holder TM, Ashcraft KW. Scrotal ecchymosis: sign of intraperitoneal hemorrhage in the newborn South Med J. 1982; 75:1471–5.
8. Choo GY, Chung YG, Kim YJ, Chung JS, Kang SC, Lee T. Bilateral neonatal torsion of testis. Korean J Urol. 2006; 47:794–6.
crossref

Fig. 1.
Swelling and discoloration of the right groin and scrotum.
kju-48-757f1.tif
Fig. 2.
The scrotal (A) and transabdominal (B) ultrasonography demonstrated a right testis (T) with surrounding hematoma (H) and a retroperitoneal hematoma (R) above the right kidney (K).
kju-48-757f2.tif
Fig. 3.
Magnetic resonance imaging demonstrated a retroperitoneal hematoma (H) with low, heterogeneous signal intensity on the T2-weighted image (A), and this was not enhanced on the contrast enhanced T1-weighted image (B).
kju-48-757f3.tif
Table 1.
The reported cases of neonatal adrenal hemorrhage presenting as acute scrotum: clinical characteristics of the patients
Investigators Laterality Gestation period (weeks) Birth weight (g) Onset after birth Anemia Location of scrotal hematoma Scrotal exploration
Putnam, 1989 Right 36 3,110 36 hours + OT +
Karpe and Nybonde, 1989 Right 40 3,750 4th day ? IT +
  Right 40 4,220 3rd day ?   ?
  Left 40 4,050 1st day ?   ?
Giacoia and Cravens, 1990 Right 40 4,260 30 hours + IT +
Liu et al., 1994 Right 40 3,000 8th day + OT +
  Right 38 3,500 3rd day ?   ?
Thambi Dorai et al., 1994 Right 38 4,400 12 hours + OT +
Yang et al., 1995 Right 38 3,530 50 hours ?   ?
Miele et al., 1997 Right 40 2,900 12 hours + OT +
  Right 39 4,380 3rd day     ?
  Left 39 3,550 4th day     ?
Andig et al., 2000 Left 37 4,490 2nd day     +
  Left 39 5,300 3rd day     ?
  Right 39 4,260 3rd day     ?
Miele et al., 2000 Right 40 3,230 2nd day     ?
Kirby and Davidson, 2000 Right 37 3,350 4th day     ?
Avolio et al., 2002 Right   3,000 24 hours ? OT +
  Right   3,400 24 hours ?   ?
O'Neill et al., 2003 Right   4,700 At birth     ?
Duman et al., 2004 Right 40 4,200 20 hours + IT +
Ibanez et al., 2004 Right 40 3,400 3rd day ?   ?
Adorisio et al., 2007 Right 40 3,700 48 hours ?   ?

OT: outside of the tunica vaginalis, IT: inside of the tunica vaginalis

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