ABSTRACT
Retroperitoneal hemorrhage is known to cause bruising of flanks (Turner's sign), umbilicus
(Cullen's sign), pubis and groin (Stabler's sign), upper thigh (Fox's sign), or scrotum
(Bryant's sign). Spontaneous adrenal hemorrhage is the most common cause of nontraumatic
parietal ecchymosis sign in neonates. Only 20 such neonatal cases have been reported
in the literature. Because all of them were of benign etiology, conservative management
is generally recommended in the presence of this sign. We report the sign for the
first time in a case of spontaneously ruptured adrenal neuroblastoma of newborn. Perinatal
physicians need to be aware of this unusual presentation of neonatal neuroblastoma.
KEYWORDS
Neuroblastoma - adrenal hemorrhage - inguinoscrotal ecchymosis - physical sign - spontaneous
tumor rupture - newborn oncology
REFERENCES
- 1
Turner G G.
Local discoloration of the abdominal wall as a sign of acute pancreatitis.
Br J Surg.
1920;
7
394-395
- 2
Farzaneh-Far A.
Cullen's and Turner's signs.
N Engl J Med.
2006;
354
979-980
- 3
Stabler F.
A case showing Cullen's sign.
BMJ.
1934;
2
255-256
- 4
Fox J A.
A diagnostic sign of extraperitoneal hemorrhage.
Br J Surg.
1966;
53
193-195
- 5
Ratzan R M, Donaldson M C, Foster J H, Walzak M P.
The blue scrotum sign of Bryant: a diagnostic clue to ruptured abdominal aortic aneurysm.
J Emerg Med.
1987;
5
323-329
- 6
Kirby C P, Davidson P M.
Inguinoscrotal bruising: a sign of neonatal adrenal hemorrhage.
Pediatr Emerg Care.
2000;
16
179
- 7
Avolio L, Fusillo M, Ferrari G, Chiara A, Bragheri R.
Neonatal adrenal hemorrhage manifesting as acute scrotum: timely diagnosis prevents
unnecessary surgery.
Urology.
2002;
59
601
- 8
Miele V, Galluzzo M, Patti G, Mazzoni G, Calisti A, Valenti M.
Scrotal hematoma due to neonatal adrenal hemorrhage: the value of ultrasonography
in avoiding unnecessary surgery.
Pediatr Radiol.
1997;
27
672-674
- 9
Duman N, Oren H, Gulcan H, Kumral A, Olguner M, Ozkan H.
Scrotal hematoma due to neonatal adrenal hemorrhage.
Pediatr Int.
2004;
46
360-362
- 10
Amoury R A, Barth G W, Hall R T, Rhodes P G, Holder T M, Ashcraft K W.
Scrotal ecchymosis: sign of intraperitoneal hemorrhage in the newborn.
South Med J.
1982;
75
1471-5, 1478
- 11
Vachharajani A, Paes B.
Spontaneous rupture of the liver presenting as scrotal bruising.
Am J Perinatol.
2001;
18
147-149
- 12 Berthold F, Simon T.
Clinical presentation. In: Cheung NKV, Cohn SL Neuroblastoma. Berlin; Springer-Verlag 2005: 63-85
- 13
Murthy T V, Irving I M, Lister J.
Massive adrenal hemorrhage in neonatal neuroblastoma.
J Pediatr Surg.
1978;
13
31-34
- 14
Breit S, Ashman K, Wilting J et al..
The N-myc oncogene in human neuroblastoma cells: down-regulation of an angiogenesis inhibitor
identified as Activin A.
Cancer Res.
2000;
60
4596-4601
- 15
Mascarin M, De Bernardi B, Brisigotti M et al..
Neuroblastoma-tumor rupture as an unfavorable prognostic factor.
Pediatr Med Chir.
1991;
13
359-363
, (English abstract)
V. Raveenthiran
Professor of Pediatric Surgery
7. Medical Faculty Quarters, Annamalai Nagar 608002, Tamilnadu, India