Renal Vein and Inferior Vena Cava Thrombosis in Neonates With Adrenal Hemorrhage: Gray‐Scale Clues Beyond Doppler

BACKGROUND: Neonatal adrenal hemorrhage is usually followed sonographically to document evolution and exclude congenital adrenal masses. In some neonates, it may be the visible suprarenal component of renal vein and/or inferior vena cava thrombosis. METHODS: We retrospectively reviewed neonates with sonographic adrenal hemorrhage and concomitant renal vein and/or inferior vena cava thrombosis identified through a 2015-2025 institutional database search. Medical records, radiology reports, ultrasound images, gray-scale and Doppler findings, venous involvement, and follow-up imaging were reviewed. RESULTS: Eight neonates with sonographic adrenal hemorrhage and concomitant renal vein and/or inferior vena cava thrombosis met inclusion criteria. Adrenal hemorrhage was unilateral, left-sided in six and right-sided in two. During the imaging course, ipsilateral renal gray-scale abnormalities were identified in all neonates, including apparent renal enlargement in six and intrarenal echogenic linear streaks in seven. Inferior vena cava thrombus was visible on gray-scale imaging in all cases. Renal hilar venous flow was detectable in all six neonates evaluated with ipsilateral renal Doppler, despite renal vein thrombosis. CONCLUSION: In neonates with adrenal hemorrhage, meticulous gray-scale assessment of both kidneys, renal veins, and inferior vena cava, followed by targeted Doppler, may improve recognition of associated venous thrombosis.