Letter to the Editor - Neonatal Adrenal Haemorrhagic Pseudocyst

A seven days old male neonate born to a diabetic mother (mild gestational diabetes) at term after an uncomplicated pregnancy with a birth weight of 3000gms, presented with a left sided flank mass. The neonate was otherwise asymptomatic. Standard laboratory tests were unremarkable. Ultrasound revealed a non-homogenous cystic mass lesion 3.9cm x 3.2cm at the upper pole of left kidney. Spiral un-enhanced computerised tomographic (CT) scan revealed a left renal mass measuring about 5 cm x 4.2cm x 6.5cm.The right kidney was essentially normal. Nuclear scan revealed an area of photopenia seen in the upper pole of the left kidney probably due to tumour as noted previously on the CT scan. This had displaced the left kidney slightly inferiorly. The right kidney had a normal configuration. The provisional diagnosis was made as congenital neuroblastoma. Surgical exploration was decided upon to exclude malignancy. At laparotomy, the right kidney was normal to palpate. Liver was normal. The left kidney showed foetal lobulations. A cystic mass was palpated in close proximity to the upper pole of the left kidney with no plane between the mass and the renal capsule. With a strong suspicion of malignancy, a radical left nephrectomy was done. Postoperative course was uneventful. Final histopathology revealed adrenal haemorrhagic pseudocyst, fetal lobulations of the left kidney with normal renal parenchymal structures.