Suprarenal haematoma versus neuroblastoma complicated by haemorrhage. A diagnostic dilemma in the newborn.

Concomitant neonatal suprarenal haemorrhage and neuroblastoma is rare. The clinical and radiologic manifestations recorded in 11 patients with this entity are compared with the findings in 32 cases with simple adrenal haemorrhage. Because of the many similarities in presentation the combined lesion must always be considered when a neonate is found to have a retroperitoneal, extra-renal mass. Our present approach to the investigation includes conventional chest and abdominal radiography aimed to demonstrate possible paravertebral widening. Serial ultrasonographies are easy to carry out and indispensable. The low specificity of urography makes us refrain from this modality as a routine. Scintigraphy, in infants and children considered useful in demonstrating extent and spread of neuroblastoma, has hardly been employed in neonates. The true value of the modality in this particular age group remains to be settled. CT scanning does not seem to provide essential information additional to that of sonography and may therefore be excluded from the protocol. Determination of urinary excretion of catecholamine metabolites is of crucial significance and a compulsory part of the investigation.