THE JOURNAL OF PEDIATRICS � www.jpeds.com REDISCOVERING THE PHYSICAL EXAM Painless Scrotal Hematoma as a Sign of Adrenal Hemorrhage in Newborns 4220-g male infant was born at 40 weeks’ gestation to a 24-year-old mother by spontaneous vaginal de- A livery. The newborn 1- and 5-minute Apgar scores were 7 and 8, respectively. Scrotal swelling and discoloration were noted 48 hours after birth. Findings of a physical examina- tion showed hypospadias and an enlarged and discolored right hemiscrotum (Figure 1). Ultrasound study of the abdomen re- vealed a cystic mass (25 × 20 mm) suggesting adrenal hem- orrhage on the upper pole of the right kidney (Figure 2; available at www.jpeds.com). Ultrasonography revealed an edematous scrotum with marked thickening of subcutane- ous tissue. At age 14 days, the patient’s physical examination was normal due to spontaneous recovery. Neonatal adrenal hemorrhage, which occurs in 0.2% of newborns, is more commonly associated with perinatal hypoxia and difﬁcult or traumatic delivery, or it can be spontaneous. Clinical manifestations of neonatal adrenal hemorrhage are variable, depending on the degree and rate of hemorrhage, as well as the amount of adrenal cortex compromised by hemorrhage. A large amount of blood can cause the rupture into
The Journal of Pediatrics – Elsevier
Published: Mar 1, 2018
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