新生儿阴囊血肿（Neonatal hematoma of scrotum）

新生儿阴囊血肿（Neonatal hematoma of scrotum） 新生儿阴囊血肿(Neonatal hematoma of scrotum) Neonatal vitamin K deficiency with scrotal hematoma as the main manifestation: a report of 1 cases Liu Enci Du Fengrong Classification number: R72 document identification code: B The male patient was born 3 D, full-term, natural labor, due to scrotal swelling 2 D admission. Physical examination: 36.5 C T, R 40 /min, HR 140 /min, weight 3.3 kg, God, good response, breath smooth, moderate skin sclera yellow dye, right lower abdomen near the groin visible ecchymosis in 1 cm * 2.5 cm, bregmatic flat and soft, round and other bilateral pupil to light sensentive, heart and lung abnormalities, the abdomen is soft, no tenderness and rebound tenderness, liver and spleen were palpable, normal bowel sounds, normal muscular tension, hugging, sucking, gripping normal reflex. Scrotal obvious swelling, dark purple, can touch 3 cm x 5 cm size block, qualitative, fixed, tenderness, transmission test negative. Auxiliary examination: WBC 10.3 x 109/L, N 0.626, L 0.282, Hb 165 g/L, RBC 4.98 x 1012/L, Plt 180 x 109/L. The prothrombin time of 68 s was significantly longer than that of the control 12.5 s, and the total bilirubin was 212.04 umol/L. Admission diagnosis: (1) neonatal hemorrhagic disease; (2) neonatal hyperbilirubinemia. All the patients were treated with vitamin K1 supplementation, Reptilase and plasma infusion for 2 D, third days after normal prothrombin time, hematoma of the scrotum without narrowing, fourth days to the hospital examination, abdominal ultrasound and CT hematoma of the right adrenal gland was 2 cm * 3 cm, 15 d after hospitalization, scrotal hematoma absorption, adrenal hematoma reduced to 1 cm * 1 cm, cured. The common manifestations of neonatal vitamin K deficiency are gastrointestinal bleeding, umbilical hemorrhage, intracranial hemorrhage, hematoma of the scrotum and adrenal hematoma, which are rarely reported in the literature. The patients with vitamin K1 treatment significantly, treatment 2 D, normal prothrombin time, for the cases of adrenal hematoma without clinical abnormalities, patients without abdominal pain, abdominal distension, abdominal muscle tension, the spirit of good, so it missed the stomach Naka. Therefore, we suggest that in the future, children with vitamin K deficiency should have routine abdominal ultrasound to understand the condition of abdominal organs, and the condition can be further checked by CT to exclude other complications. Author: Liu Enci (Yangjiang Maternal and Child Health-Care Station of 529500 Guangdong province) Du Fengrong (Yangjiang Maternal and Child Health-Care Station, 529500 Guangdong province) Doctor Qian Qiangying (pediatric B ultrasonic room Affiliated Hospital of Shanghai Medical University): B ultrasonic room of our hospital were detected in 8 cases of neonatal adrenal hemorrhage, the clinical diagnosis of 1 cases of neonatal birth trauma, natural 1 cases in 6 cases of neonatal asphyxia, 1 cases of clinical disease and only consider the abdominal ultrasonography, were found more than other diagnostic abdominal ultrasound examination when. Neonatal adrenal body weight accounted for 2%, 20 times larger than adults, so prone to birth trauma hemorrhage. It is reported that neonatal adrenal hemorrhage often unilateral, right side accounted for 70%, bilateral bleeding accounted for 5% to 10%. Clinical manifestations have no specificity, light people can be asymptomatic, clinical attention should be paid to the detailed history of the disease, attention to the disease. In the acute hemorrhagic stage, the heterogeneous masses with liquid dark area above the kidney were found by B-mode ultrasonography. With the extension of the course, the blood clot shrank, the tumor shrank, the spots increased, and calcification occurred. Ultrasonographic evaluation of neonatal adrenal hemorrhage Li Lin Qi Guoxin Peng Wenxiu Wang Xiuping Zheng Jinsheng Objective: To investigate the risk factors, sonographic features and prognosis of neonatal adrenal hemorrhage. Methods: 25 cases of hospitalized neonates were examined with supine, bilateral, coronal, and transverse scans of the adrenal gland and kidneys. Results: in 25 cases of adrenal hemorrhage, 17 cases were male and 8 cases were female. There were 20 cases of right adrenal hemorrhage and 5 cases of left side, 3 cases with hepatic hematoma, perirenal hematoma and scrotal hematoma respectively. The sonographic features of adrenal hemorrhage were low or moderate echo masses in the adrenal gland. Conclusion: the main risk factors of neonatal adrenal hemorrhage are antepartum or productive asphyxia, fetal macrosomia, dystocia and violent injury. The clinical manifestations are lack of specificity. Sonographic features are characteristic, As the main diagnostic method, the common complications are renal vein thrombosis and scrotal hematoma. Adrenal hemorrhage can be absorbed, reduced or even disappeared after 6~8 weeks, and residual adrenal calcification can be seen. Keywords neonatal adrenal hemorrhage ultrasound examination Ultrasonographic Evaluation of Neonatal Adrenal Hemorrhage Li Lin, Zheng Jinsheng, Qi Guoxing, et al (Tianjin Children's Hospital, Tianjin 300074 China) ABSTRACT Objective:To discuss the sonographic manifestations, the pathogenesis and the prognosis of neonatal adrenal hemorrhage (NAH).Methods: Twenty-five newborn's adrenals and kidneys were scaned in coronary and transverse sections when the baby in supine or oblique position.Results:There are with right adrenal hemorrhage 20 patients and 5 patients with left. Three patients associate with hepatic hemorrhage, perirenal hematoma and scrotal hematoma.The NAH appeared as mix mass in the area of neonatal adrenal.The main pathogenesis of NAH is due to perinatal asphyxia, large size of the baby, difficult delivery or any accident violence. Conclusion:sonograms have specific features of NAH being the main tool for examination. NAH often associate S with renal vein thrombosis and scrotal hematoma.Adrenal hemorrhage may disappear after left. 6-8 weeks with calcification KEY WORDS Newborn Adrenal hemorrhage Ultrasonography Adrenal hemorrhage is a common disease of newborn, clinical manifestations of anemia, although jaundice, abdominal distension and abdominal mass, and the final diagnosis mainly depends on imaging examination, but the relevant domestic few reports, the ultrasound examination in our hospital 25 cases of patients with clinical conditions as follows. Data and methods From January 1994 to October 1999 in our hospital 25 cases of neonatal hospitalization, male 17 cases, female 8 cases, age ranged from 9 hours to 28 days, of which 14 cases of less than 10 days. There were 20 cases of right adrenal hemorrhage and 5 cases of left adrenal hemorrhage. CT examination was performed in 15 children, and abdominal CT examination was performed in 6 cases. 25 cases of 21 cases of full-term infants, 16 cases of hypoxic ischemic encephalopathy (HIE), 3 cases of jaundice, 2 cases of omphalitis, septicemia, the rest were neonatal pneumonia, hematuria of unknown origin, vomiting of unknown origin etc.. 19 cases had definite history of asphyxia during prenatal or birth, and 6 cases were rescued by artificial respiration after asphyxia. All children did not touch the abdominal mass, 4 cases of children with hemoglobin less than 12g/dl, 3 cases of birth weight greater than 4kg, 5 cases of cesarean section. Using GERT 3000 and ATL Apogee 800P ultrasonic diagnostic instrument, 5MHz fan scan, 7 ~ 3MHz convex array or 11 ~ 5MHz line matrix probe. The liver, gallbladder, pancreas, spleen, kidney and adrenal gland were scanned routinely in supine position, and the sections of adrenal hemorrhage were scanned. Result Adrenal hemorrhage occurred in 20 cases of right side and 5 cases in left side. Left adrenal hemorrhage with right perirenal hematoma in 1 cases, right adrenal hemorrhage with right liver lobe hematoma in 1 cases, right adrenal hemorrhage with right perirenal hematoma and ipsilateral scrotal hematoma in 1 cases. Among the 15 children who underwent CT examination, 14 cases showed HIE with varying degrees, including 7 cases with subarachnoid hemorrhage and 1 cases with right occipital lobe softening lesion. Abdominal CT showed adrenal hemorrhage in 6 cases (right side in 5 cases, left side in 1 cases), consistent with US results. No blood flow was detected in the adrenal hemorrhage sites in 8 children who underwent color Doppler ultrasonography. Sonographic appearance, Above the kidneys showed heterogeneous mixed echo mass (Figure 1), including 15 cases of low echo echo in 7 cases, no strong echo in 3 cases (Figure 2). The mass was usually 2cm x 3cm in size, with small echo free areas, clear boundaries, regular morphology, and unclear adrenal glands. 3 cases of adrenal hemorrhage had slight indentation on the superior pole of kidney, and 3 cases had blood abdomen. In 25 cases, 10 cases were followed up for 1 months to 1 years, and the adrenal hemorrhage range was reduced in 8 cases at 6 weeks (Fig. 3). At 8 weeks, 6 cases of adrenal hemorrhage disappeared, and the strong echo adrenal gland was seen. There were no false positive or misdiagnosed cases, and none of the children died after treatment. Figure 1 right adrenal region 2.5cm x 3cm uneven echo mass, the right kidney upper pole produces the mark, the normal adrenal gland disappears. Figure 2 right adrenal gland diameter 2.8cm homogeneous non echo mass, regular morphology, normal adrenal gland disappeared. In 3 and 1 of the same children, the size of the adrenal hemorrhage decreased significantly after 42 days, which was 1cm x 0.8cm in size, showing hypoechoic masses surrounded by hyperechoic rings. Discussion Neonatal adrenal hemorrhage is considered to be due to intrauterine or production of asphyxia, excessive fetal, dystocia or birth injury, coagulation disorders of systemic diseases in adrenal manifestations and other factors [1, 2]. More likely to invade the baby boy, 4~5 times as much on the right side as on the left side. In addition to hypoxia factors, right adrenal gland located in the liver and the spine, the vein openings in the inferior vena cava, easy to be crushed after injury is easily affected by the effects of elevated venous pressure and hemorrhage in 3, this may be a factor more than the left side of the right adrenal hemorrhage. In this group, 3 cases were combined with perirenal hematoma or liver hematoma, and 6 cases had the history of artificial respiration after delivery, so the support of birth injury and external violence were also the factors causing adrenal hemorrhage. After the hemorrhage, the clinical manifestations of pelvic hemorrhage, jaundice, abdominal mass and so on [2, 3], and this group of patients lack of these characteristics of clinical manifestations, adrenal hemorrhage were found by US. In normal newborns, the adrenal US is characterized by 'human' or 'V', and the central linear strong echo represents the medulla, and the low echo surrounding the cortex represents the cortex. When the adrenal gland bleeds, all or one adrenal gland disappears, instead of hematoma. Echo form and hematomas of the time early, mainly for low echo or strong echo mass, scattered in the central echo free zone (liquefied), liquefied area further reduce mass absorption become low echo, 8 weeks after the hematoma mostly disappeared. After hematoma disappearance, adrenal gland calcification may be found in some cases. Therefore, in infants, children, US or abdominal plain film, calcification of the adrenal gland is found. If there is no associated mass or other abnormal manifestations, there is no need for further examination, indicating that adrenal hemorrhage occurred during the neonatal period. Neonatal adrenal hemorrhage is generally confined to adrenal hematoma formation in the membrane, the volume of bleeding by membrane rupture, bleeding along the retroperitoneal space spread down and the formation of hematocelia, and further open the tube into the scrotum through the inguinal and scrotal hematoma formation in 4. Scrotal hematoma, clinical manifestations of scrotal swelling, skin black purple, often misdiagnosed as testicular torsion, US rib in the differential diagnosis, so as to avoid unnecessary surgery. When the scrotum in US is suspected of scrotal hematoma, the bilateral adrenal glands should be further examined to avoid the possibility of adrenal hemorrhage. Neonatal adrenal hemorrhage, especially left adrenal hemorrhage, may be associated with renal vein thrombosis. This may be due to the anatomical relationship between the left renal vein and the left adrenal vein. The left adrenal vein enters the left renal vein at first and then to the inferior vena cava and right adrenal vein directly into the inferior vena cava, the left adrenal hemorrhage after the thrombus can be disseminated to the relative (inferior vena cava) left renal vein, thin 5. When there was thrombus in the main renal vein, the ultrasound showed enlargement of the affected kidney and echo enhancement, and the boundary between the medulla and the medulla was not clear. In the small renal vein thrombosis, according to the size and scope of thrombus, the size and echo intensity of the kidney are different, which can show the strong echo fringes of the renal margin. Severe renal vein thrombosis eventually leads to renal atrophy. Neonatal adrenal hemorrhage should be differentiated from renal and retroperitoneal tumors. The kidney is a congenital malformation of the urinary system, and the adrenal gland is normal. The retroperitoneal tumor is characterized by inhomogeneous echo of solid mass, which produces marked compression and displacement of the kidney. Color Doppler can be used to detect the bleeding in the tumor. Because of the low tension, most of the adrenal hemorrhage does not produce the impression or displacement of the kidney. Neonatal adrenal hemorrhage generally does not appear to be life-threatening, but during this period, if combined with sepsis, the hematoma can become a bacterial medium for the growth of bacteria and the formation of adrenal abscess [1]. Escherichia coli is the most common pathogen. Adrenal gland mass, accompanied by high fever and infection signs, should be considered in infants with adrenal abscess. Neonatal adrenal hemorrhage is characterized by lack of clinical manifestations, mostly incidental imaging findings. The sonographic features of adrenal hemorrhage are characterized by features of asphyxia, dystocia and salvage after birth. Routine abdominal ultrasonography should be performed. Li Lin (Department of functional examination, Tianjin Children's Hospital, 300074) Zheng Jinsheng (Department of functional examination, Tianjin Children's Hospital, 300074) Qi Guoxin (Department of functional examination, Tianjin Children's Hospital, 300074) Peng Wenxiu (Department of functional examination, Tianjin Children's Hospital, 300074) Wang Xiuping (Department of functional examination, Tianjin Children's Hospital, 300074) Reference 1, Rita Littlewood Teele, Jane Chrestman Share, Ultrasonography of Infants and Children, Lisette Bralow, 1991241 ~ 242. 2, Jin Hanzhen, Huang Demin, Guan XJ. Practical neonatology. Second edition, Beijing: People's Medical Publishing House, 1997781. 3, Wu Ruiping, Hu Yamei, Jiang m, ed. Zhu Futang Practical Pediatrics. Sixth edition, Beijing: People's Medical Publishing House, 1996489. 4, Miele V, Galluzzo M, Patti Gianluca, et al.Scrotal hematoma due to neonatal adrenal hemorrhage:The value of ultrasonography in avoiding unnecessary surgery.Pediatr Radiol, 1997,27:672 ~ 674. 5, Orazi C, Fariello G, Malena S, et al.Renal vein thrombosis and adrenal hemorrhage in the newborn:Ultrasound evaluation of 4 cases.JCU, 1993,21:163 ~ 169. (received 2000-03-22, published 208 days)