Journal of Postgraduate Medicine
 Open access journal indexed with Index Medicus & ISI's SCI  
Users online: 5246  
Home | Subscribe | Feedback | Login 
About Latest Articles Back-Issues Article Submission Resources Sections Etcetera Contact
 
  NAVIGATE Here 
  Search
 
 :: Next article
 :: Previous article 
 :: Table of Contents
  
 RESOURCE Links
 ::  Similar in PUBMED
 ::  Search Pubmed for
 ::  Search in Google Scholar for
 ::Related articles
 ::  Article in PDF (204 KB)
 ::  Citation Manager
 ::  Access Statistics
 ::  Reader Comments
 ::  Email Alert *
 ::  Add to My List *
* Registration required (free) 

  IN THIS Article
 ::  References

 Article Access Statistics
    Viewed5775    
    Printed189    
    Emailed5    
    PDF Downloaded158    
    Comments [Add]    
    Cited by others 3    

Recommend this journal


 


 
LETTER TO EDITOR
Year : 2002  |  Volume : 48  |  Issue : 3  |  Page : 239-40

Neonatal adrenal haemorrhagic pseudocyst.




Correspondence Address:
J Z Patankar


Login to access the Email id

Source of Support: None, Conflict of Interest: None


PMID: 12432209

Rights and PermissionsRights and Permissions



Keywords: Adrenal Gland Diseases, diagnosis,surgery,Case Report, Cysts, diagnosis,surgery,Follow-Up Studies, Hemorrhage, diagnosis,surgery,Human, Infant, Newborn, Laparotomy, Male, Nephrectomy, methods,Risk Assessment, Tomography, X-Ray Computed, Treatment Outcome, Ultrasonography, Doppler,


How to cite this article:
Patankar J Z, Mali V P, Prabhakaran K. Neonatal adrenal haemorrhagic pseudocyst. J Postgrad Med 2002;48:239

How to cite this URL:
Patankar J Z, Mali V P, Prabhakaran K. Neonatal adrenal haemorrhagic pseudocyst. J Postgrad Med [serial online] 2002 [cited 2019 Nov 18];48:239. Available from: http://www.jpgmonline.com/text.asp?2002/48/3/239/92


Sir,

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.

Adrenal haemorrhage (AH) is not an exceptional event in the newborn. The probable predisposing factors are difficult delivery, foetal hypoxia, thrombocytopenia and coagulation defects. Additional risk factors are maternal diabetes, breech delivery, perinatal asphyxia and neonatal sepsis. The differentiation between neonatal neuroblastoma and adrenal haemorrhage may be very difficult in any individual case. A high index of suspicion is required to make a timely diagnosis of AH.

Clinical and radiological differential diagnosis for a left sided abdominal mass in a newborn may be neonatal adrenal haemorrhage, congenital neuroblastoma and retroperitoneal teratoma. The sonographic appearance of an AH is an echogenic suprarenal mass which is difficult to distinguish from a congenital neuroblastoma. Sonographic differentiation may be very difficult as neonatal neuroblastoma may have a cystic appearance[1] and AH may present as a solid suprarenal mass. Haemorrhage into a congenital neuroblastoma may occur which makes the differentiation between AH and neuroblastoma extremely difficult.[2],[3]

Colour coded Doppler sonography is useful to differentiate between congenital neuroblastoma and AH. In neuroblastoma it shows a network of microscopic vessels that invade the tumour and provide blood supply essential for its growth.[4] This network gives rise to characteristic high velocity Doppler shifts. In contrast to neuroblastoma, AH is characterised by diminished or absent blood flow.

Our case highlights the diagnostic problems that arise when a space-occupying lesion is found near or at the adrenal gland. The absence of signs of bleed (shock, anemia or hemolytic jaundice) cannot be taken as proof that a neoplasm is present. Although surgical exploration has been advised to exclude malignancy, it is imperative to try to make the differentiation by non-operative means, such as repeated ultrasound, CT-scan and fine needle aspiration biopsy. Non-operative management of neonatal AH gives excellent results, whereas too aggressive approach may end in the removal of non-diseased organs.[5]

 
 :: References Top

1.Croitoru DP, Sinsky AB, Laberge LM. Cystic neuroblastoma. J Pediatr Surg 1992;27:1320-1.  Back to cited text no. 1    
2.Ekloef O, Mortenson W, Sandstedt B. Suprarenal haematoma versus neuroblastoma complicated by haemorrhage. A diagnostic dilemma in the newborn. Acta Radiologica 1986;27:3-10.  Back to cited text no. 2    
3.Smoljanic Z, Zivic G, Kos R, Krstic Z. Adrenal gland hemorrhage in neonates radiologic aspects. Srp Arh Celok Lek 1997;125: 295-8.  Back to cited text no. 3    
4.Deeg KH, Bettendorf U, Hofmann V. Differential diagnosis of neonatal adrenal haemorrhage and congenital neuroblastoma by colour coded Doppler sonography and power Doppler sonography. Eur J Pediatr 1998;157:294-7.  Back to cited text no. 4    
5.Hanimann B, Morger R. Adrenal haemorrhage in newborn. Z Kinderchir [Suppl] 1983;38:59.  Back to cited text no. 5    



This article has been cited by
1 Prenatal diagnosis of an adrenal cystic tumor: Action that must be taken | [Diagnóstico prenatal de una tumoración quística suprarrenal: Conducta que hay que seguir]
Bermejo, R., Palacios, A., Saco, L., Fernández-Ramírez, M.J., Díaz, C.
Clinica e Investigacion en Ginecologia y Obstetricia. 2008; 35(6): 231-234
[Pubmed]
2 Neonatal adrenal hemorrhage presenting as a multiloculated cystic mass
Wang, C.-H., Chen, S.-J., Yang, L.-Y., Tang, R.-B.
Journal of the Chinese Medical Association. 2008; 71(9): 481-484
[Pubmed]
3 Adrenal pseudocyst presenting as acute abdomen during pregnancy
Papaziogas B, Katsikas B, Psaralexis K, et al.
ACTA CHIRURGICA BELGICA. 2006; 106 (6): 722-725
[Pubmed]



 

Top
Print this article  Email this article
Previous article Next article
Online since 12th February '04
2004 - Journal of Postgraduate Medicine
Official Publication of the Staff Society of the Seth GS Medical College and KEM Hospital, Mumbai, India
Published by Wolters Kluwer - Medknow