Case of the Day(sm)

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One-day-old undergoing GU workup.

Our appreciation is extended to Dr. Kulia Matsuo,
Indiana University Department of Radiology,
for contributing this case.

History: One-day-old undergoing GU workup.

Click these images to enlarge them.

Which choice best describes the salient findings?

Suprarenal mass.Hydronephrosis.Duplication.Multicystic dysplastic kidney.Focal renal mass.

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Case of the Day(SM) Copyright

Case of the Day(sm)

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One-day-old undergoing GU workup.

Here are images from a follow-up ultrasound obtained 2 weeks later. Click to enlarge. There has been no therapeutic intervention since the original ultrasound.

Can you select the actual diagnosis for the finding?

Neuroblastoma.Adrenal hemorrhage.Congenital adrenal hyperplasia.Glycogen storage disease.Teratoma.

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Case of the Day(SM) Copyright

Case of the Day(sm)

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One-day-old undergoing GU workup.

Findings: Initial ultrasound shows a cystic / septated right adrenal mass. Two weeks follow-up shows that this mass had involuted into a smaller soft tissue component. Two months after that (not shown) the mass had resolved. Intrinsically normal right kidney.

Differential diagnosis:

Involuting hemorrhage
Neuroblastoma
Congenital adrenal hyperplasia
Wolman disease
Subdiaphragmatic pulmonary sequestration

Diagnosis: Adrenal hemorrhage, involuting over two weeks.

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Case of the Day(SM) Copyright

Case of the Day(sm)

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One-day-old undergoing GU workup.

Key points:

Acute hemorrhage appearance: Echogenic, mass like.
Subacute hemorrhage appearance: Mixed echogenic mass because blood products are liquefying and contracting.
Chronic hemorrhage appearance: Gland resumes normal size, may calcify.
Ultrasound is best for diagnosis and follow up.
Doppler interrogation is helpful because the hematoma is avascular. Neuroblastomas are highly vascular.
If lesion increases in size over time, do MR to document the characteristic signal intensity of aging blood

References: