Neonatal adrenal hemorrhage presenting as a multiloculated cystic mass

Neonatal adrenal hemorrhage presenting as an abdominal mass in the newborn is not uncommon. However, judging the nature of a suprarenal mass is sometimes difficult, especially when the structure is more complex with unusual clinical course. We report a male newborn with neonatal adrenal hemorrhage presenting as a multiloculated cystic mass. The margins between the mass and left kidney were indistinct. All laboratory data including complete blood cell count, serum electrolytes, liver function, renal function, blood sugar, alpha-fetoprotein, beta-human chorionic gonadotropin, urinalysis, and 24-hour urine vanillylmandelic acid were within normal limits. Serial sonographic follow-up revealed failure to decrease in size without change in echogenicity. Surgical exploration was performed to exclude the possibility of malignancy. This case highlights the diagnostic problems that arise when a space-occupying lesion is found near or at the adrenal gland in the neonate. We suggest that early surgical intervention for the suprarenal mass without sufficient evidence of malignancy would not be prudent.