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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