产前超声诊断胎儿肾上腺血肿1例并文献复习  

Diagnosis of fetal adrenal hematoma through prenatal ultrasound:a case report and literature review

作　　者：何旭昱 李小花[2] 毛森[2] 史文静 He Xuyu;Li Xiaohua;Mao Sen;Shi Wenjing(School of Clinical Medicine,Jining Medical University,Jining 272013,China;Department of Ultrasonography,Affiliated Hospital of Jining Medical University,Jining 272029,China)

机构地区：[1]济宁医学院临床医学院,济宁272013 [2]济宁医学院附属医院超声科,济宁272029

出　　处：《中华围产医学杂志》2024年第2期148-153,共6页Chinese Journal of Perinatal Medicine

基　　金：济宁市重点研发计划(2022YXNS024);济宁市重点研发计划(软科学项目)(2022JNZC054)。

摘　　要：目的探讨胎儿肾上腺血肿(adrenal hematoma,AH)的超声特征及演变规律。方法回顾性分析济宁医学院附属医院诊断的1例胎儿AH的病例资料。检索中华医学期刊全文数据库、知网数据库、万方数据库及PubMed数据库自1989年1月1日至2022年12月31日发表的胎儿AH的相关病例。总结胎儿AH的临床特点、声像图特征、干预措施及预后等。采用描述性统计分析。结果(1)本例:孕36周+3超声发现胎儿左侧肾上腺区混合性回声结节,边界清晰,内无明显血流信号,考虑胎儿AH。产前及生后密切超声随访,病灶体积稍增大,之后病灶逐渐缩小且由混合性回声逐渐向实性回声转变,1岁8月龄病灶完全液化吸收。(2)文献复习:共检索到诊断明确且有超声资料的胎儿AH病例12例,加之本例,共13例。胎儿AH孕妇无临床表现,患儿生后亦无典型临床表现,出血量较大和/或双侧肾上腺出血时可有轻度黄疸、喂养困难等表现。2例终止妊娠,1例生后死于Galen静脉动脉瘤导致的心力衰竭,余10例存活。胎儿AH超声图像特征有时间相关性变化,依次表现为无回声、实性回声、混合性回声、病灶完全吸收或残留高回声。结论胎儿AH少见,超声图像特征随时间变化,具有特征性,超声严密随访是诊断胎儿AH的首选且重要的方法。ObjectiveTo investigate the ultrasonic characteristics and evolution pattern of fetal adrenal hematoma(AH).MethodsA retrospective analysis was conducted on the clinical data of one fetal AH diagnosed at the Affiliated Hospital of Jining Medical University.The study involved a comprehensive search of the relevant cases of fetal AH published from January 1,1989,to December 31,2022,in the Yiigle database,China National Knowledge Infrastructure Database,Wanfang Database,and PubMed Database.The clinical features,sonographic characteristics,interventions,and prognosis of fetal AH were summarized.Descriptive statistical analysis was used.Results(1)Case:An ultrasound at 36+3 weeks of pregnancy detected a mixed echogenic nodule at the fetal left adrenal region,with clear border and no obvious blood flow signal.Fetal AH was considered.Observations from the close ultrasound follow-up on the case before and after birth,and one year and eight months after birth presented a gradual transformation of the lesion from mixed echogenic to solid echogenic and a reduction following enlargement in lesion size.The lesion was ultimately liquefied and absorbed.(2)Literature review:A total of 12 cases of fetal AH that had clear diagnosis and ultrasound data were retrieved and added to the present case,for a total of 13 cases.Neither prenatal maternal nor postnatal typical clinical manifestations were observed in fetal AH cases.In cases with large hemorrhage and/or bilateral adrenal hemorrhage,mild jaundice and feeding difficulties may be present.Two cases were terminated,one live baby died of heart failure due to vein of Galen aneurysmal malformation,other ten had good prognosis.Fetal AH ultrasound image features demonstrated time-dependent changes,progressing in the sequence of anechoicity,solid echogenicity,mixed echogenicity,and complete absorption of the lesion,or residual hyperechogenicity.ConclusionsFetal AH is a rare condition that exhibits characteristic transformations in ultrasound image features over time.Conducting close follo

关 键 词：肾上腺疾病 血肿 超声检查 产前 诊断 鉴别 肾上腺肿瘤 神经母细胞瘤 

分 类 号：R445.1[医药卫生—影像医学与核医学] R714.5[医药卫生—诊断学]