Sonographic Diagnosis of Fetal Adrenal Hemorrhage Complicating a Vein of Galen Aneurysmal Malformation

Abstract

Background: The vein of Galen aneurysmal malformation (VGAM) is a rare intracranial vascular malformation which causes end-organ ischemia or venous congestion due to heart failure. Adrenal hemorrhage associated with VGAM has not been reported in the literature. We present the imaging findings of a fetal VGAM with adrenal hemorrhage. Case Report: A 26 year-old primigravida woman whose fetus with VGAM and mild cardiomegaly was scanned in the 34th week. On fetal ultrasound, a hyperechoic, well-circumscribed mass in the left suprarenal region was shown. Fetal and postnatal magnetic resonance imaging confirmed the diagnosis of adrenal hemorrhage. The baby died after delivery. Conclusion: Adrenal hemorrhage can complicate VGAM in fetuses with severe heart failure. Evaluation of the adrenal gland in affected cases may contribute to the prenatal counseling, and postnatal management.

Keywords

• Adrenal hemorrhage, fetal, ultrasound, vein of Galen aneurysmal malformation

References

1. 1. Deloison B, Chalouhi GE, Sonigo P, Zerah M, Millischer AE, Dumez Y, et al. Hidden mortality of prenatally diagnosed vein of Galen aneurysmal malformation: retrospective study and review of the literature. Ultrasound Obstet Gynecol 2012;40:652-8. [CrossRef]
2. 2. Schrauder MG, Hammersen G, Siemer J, Goecke TW, Meurer B, Hart N, et al. Fetal adrenal haemorrhage--two-dimensional and three-dimensional imaging. Fetal Diagn Ther 2008;23:72-5. [CrossRef]
3. 3. Schwärzler P, Bernard JP, Senat MV, Ville Y. Prenatal diagnosis of fetal adrenal masses: differentiation between hemorrhage and solid tumor by color Doppler sonography. Ultrasound Obstet Gynecol 1999;13:351-5. [CrossRef]
4. 4. Khuri FJ, Alton DJ, Hardy BE, Cook GT, Churchill BM. Adrenal hemorrhage in neonates: report of 5 cases and review of the literature. J Urol 1980;124:684-7.
5. 5. Felc Z. Ultrasound in screening for neonatal adrenal hemorrhage. Am J Perinatol 1995;12:363-6. [CrossRef]
6. 6. Maki E, Oh K, Rogers S, Sohaey R. Imaging and differential diagnosis of suprarenal masses in the fetus. J Ultrasound Med 2014;33:895-904. [CrossRef]
7. 7. Hsieh CC, Chao AS, Hsu JJ, Chang YL, Lo LM. Real-time and power Doppler imaging of fetal adrenal hemorrhage. Chang Gung Med J 2005;28:860-5.
8. 8. Li AH, Armstrong D, terBrugge KG. Endovascular treatment of vein of Galen aneurysmal malformation: management strategy and 21-year experience in Toronto. J Neurosurg Pediatr 2011;7:3-10. [CrossRef]

9. 9. Sammons V, Davidson A, Tu J, Stoodley MA. Endothelial cells in the context of brain arteriovenous malformations. J Clin Neurosci 2011;18:165-70. [CrossRef]
10. 10. Revencu N, Boon LM, Mulliken JB, Enjolras O, Cordisco MR, Burrows PE, et al. Weber syndrome, vein of Galen aneurysmal malformation, and other fastflow vascular anomalies are caused by RASA1 mutations. Hum Mutat 2008;29:959-65. [CrossRef]