Prenatal ultrasound findings and progression of fetal adrenal hemorrhage: A systematic literature review

Fetal adrenal hemorrhage (FAH) is a rare prenatal ultrasound finding with limited data regarding perinatal outcomes. Our objective was to review ultrasound findings and progression of prenatally diagnosed FAH. A systematic literature review of electronic databases including PubMed, Scopus, Web of Science, Embase, CINAHL, ClinicalTrials.gov, and Cochrane Library was conducted from inception until January 2022. All reports of prenatally identified fetal adrenal masses with a diagnosis of FAH were included. Data extracted included maternal demographics, imaging modality, prenatal ultrasound findings, and progression of ultrasound findings. A total of 35 studies were identified (Figure 1) that included 226 prenatally visualized fetal adrenal masses, of which 102 cases (45%) were confirmed as FAH. Of these studies, 24 were case reports and 11 were case series. Mean gestational age at diagnosis was 31.1 weeks (±5.2 weeks). Majority of FAH cases documented a mass on the left side (33/54, 61%). Cases were most commonly described as cystic (28/90, 31%), anechoic (25/90, 38%) or with mixed echogenicity (10/90, 11%) on initial appearance of the fetal adrenal mass on prenatal ultrasound (see Table 1). In 12 cases (12%), FAH was noted to have no internal blood flow and in 5 cases (5%), ipsilateral renal displacement was noted. FAH outcome data was available for 65 cases (64%). Of these, only 6 (9%) resolved prenatally. Postnatally, 35% (23/65) resolved completely, 34% (22/65) regressed in size, and 22% (14/65) persisted. Prenatal ultrasound findings of FAH can vary on ultrasound presentation with cystic/anechoic appearance being the most common description. Majority of these masses either regress or resolve in the postnatal period while about 20% persist after birth.View Large Image Figure ViewerDownload Hi-res image Download (PPT)