Differentiation of adrenal hemorrhage from adrenal malignancies in a neonatal case by superb microvascular imaging

Neonatal adrenal hemorrhages (NAH) may be encountered in cases of perinatal asphyxia. The differentiation of malignant lesions and bleeding in the adrenal gland detected in the neonatal period is very important for treatment and prognosis. Ultrasonography (US) is the first preferred imaging method in NAH because it is non-invasive and easy to apply. Vascularization is not detected in hematomas in Doppler US examination. However, conventional Doppler imaging techniques (CDIT) may not adequately show the blood flow (BF) of the lesions. Super micro-vascular imaging (SMI) is a new vascularization imaging technique that eliminates motion artifacts, provides detailed information about very slow blood flow, and allows imaging of microvascular structures. SMI can be operated in 2 modes: color SMI (cSMI) and monochrome SMI (mSMI). The cSMI mode simultaneously displays a conventional grayscale US with color-coded Doppler signals. The monochrome SMI mode improves the visibility of vascular structures by eliminating background signals and focusing only on vasculature signals. In this case report, we aimed to present a case of NAH detected by SMI in the neonatal period and we wanted to emphasize the usefulness of SMI.