CASE 2538 Published on 15.10.2003

Adrenal hemangioma in a neonate

Section

Paediatric radiology

Case Type

Clinical Cases

Authors

Puy R, Medina M, Capdevila A

Patient

2 days, male

Clinical History
An anechoic mass was detected in the left adrenal gland during a regular obstetrical ultrasound on the 35 weeks foetus. After delivery, the infant was referred for an ultrasound, and MRI was also performed. Blood tests were normal and catecholamine metabolites in the urine were negative.
Imaging Findings
An anechoic mass was detected in the left adrenal gland during a regular obstetrical ultrasound on the 35 weeks foetus. After delivery, the infant was referred for an ultrasound, and MRI was also performed. Blood tests were normal and catecholamine metabolites in the urine were negative.
Ultrasound and MRI confirmed a cyst-like mass in the left adrenal gland with a cystic-fluid level and without gadolinium enhancement. The mass persisted with similar characteristics in repeated imaging over a 2 months period, hence, surgical removal was practised. The histological diagnosis was that of an adrenal hemangioma of cavernous type.
Discussion
Cystic adrenal masses in the newborn are sometimes discovered incidentally. The spectrum of these lesions is large and only the most significant ones are included here, like: haemorrhage related to perinatal stress, trauma or septicaemia, haemorrhage within a tumor and cystic neuroblastoma. The latter one is a rare presentation of adrenal neuroblastoma, but in practice, it is the most important diagnosis to exclude, differentiating it from an adrenal haemorrhage in a neonate.
Adrenal haemangioma is a very uncommon benign non-functioning tumour. Approximately 30 cases have been published in the medical literature. To our knowledge the cases described in the neonatal period were all in the context of diffuse hemangiomatosis.
Adrenal haemangioma can be located in the medulla or in the cortex. The most common type described in the literature is the cavernous one.
On MRI, after gadolinium administration, 2 patterns have been described: peripheral spotty contrast enhancement with centripetal enhancement and thin rim enhancement without centripetal enhancement. When the first one pattern of contrast enhancement is present, it is quite specific and suggests an haemangioma. In the present case a complete cystic lesion was seen and no enhancement was detected after gadolinium administration. We think this could be due to the compresion of the blood vessels of the small haemangioma by the large hematoma formed after bleeding into one of the large venous haemangiomatous vessels.
Differential Diagnosis List
Adrenal cavernous hemangioma in a neonate.
Final Diagnosis
Adrenal cavernous hemangioma in a neonate.
Case information
URL: https://www.eurorad.org/case/2538
DOI: 10.1594/EURORAD/CASE.2538
ISSN: 1563-4086