Abdominal Masses

Abdominal Masses: Excerpt from In A Page: Pediatric Signs and Symptoms

Abdominal masses are common presenting signs of malignant solid tumors in children and should be presumed to be such. They require urgent evaluation to rule out compression of internal organs, hemorrhage, and/or malignancy. In newborns, an abdominal mass is most likely renal in origin; if malignant, Wilms tumor and neuroblastoma are most likely. In older children, malignant abdominal masses are usually splenic and/or hepatic infiltration with leukemia or lymphoma.

Differential Diagnosis

• Wilms tumor
  –More common in younger children
• Neuroblastoma
  –More common in younger children
• Leukemia/lymphoma
  –Involvement of retroperitoneal nodes, liver, or spleen
• Hepatic tumors
  –Hepatoblastoma, hepatocellular carcinoma, angiosarcoma, rhabdomyosarcoma of the liver, metastatic disease
• Germ cell tumors
  –Ovarian, teratoma
• Soft tissue sarcoma
  –Rhabdomyosarcoma
• Rare malignancies in children
  –Carcinoid tumors, adrenocortical carcinoma, pancreatoblastoma, malignant rhabdoid tumor
• Cystic masses
  –Ovary, renal, mesenteric
• Benign tumors
  –Adenomas (especially of liver), hamartomas, pheochromocytoma
• Vascular lesions (e.g., hemangioma)
• Renal etiologies
  –Distended, nonemptying bladder, bladder outlet obstruction
  –Congenital mesoblastic nephroma
  –Severe hydronephrosis
• Gynecologic
  –Ovarian torsion, endometriosis, pelvic inflammatory disease
• Gastrointestinal
  –Constipation/stool impaction, intestinal obstruction (e.g., Hirschsprung), GI duplication, incarcerated hernia
• Pancreatic pseudocyst
• Infectious
  –Abscess, hepatitis, virus (EBV, CMV) causing splenomegaly or hepatomegaly
• Structures normally palpable in small children are liver edge, spleen tip (especially with viral illness), aorta, sigmoid colon, and spine

Workup and Diagnosis

• History
  –Mass duration, growth rate, pain; fever, weight loss, bone pain, night sweats
  –Anorexia, vomiting, constipation or diarrhea, early satiety, jaundice; prematurity, umbilical catheterization; opsoclonus, myoclonus (neuroblastoma)
  –Vaginal bleeding/amenorrhea, sexual activity, previous pregnancies/fertility, history of STDs; urinary dysfunction, congenital urinary tract anomalies
  –Signs of catecholamine excess (sleeplessness, jitteriness, flushing, hypertension)

• Family history: Wilms tumor, neurofibromatosis, hepatic tumors, Beckwith-Wiedemann
• Physical exam: Vital signs, toxicity, pallor, puffiness; location, size, tenderness, consistency of mass; hemihypertrophy (with Wilms), lymph nodes; wheezing, rales, SVC syndrome; presence of ascites, visible venous dilation; testicular exam, rectal; pelvic examination in teenagers; petechiae, purpura/ecchymoses, café au lait spots
• Labs: CBC with differential; electrolytes, BUN, Cr, LFT albumin, urinalysis; LDH, uric acid, PT/PTT/INR, ferritin, viral titers (EBV, CMV, hepatitis), tumor markers, stool guaiac
• Studies: KUB/upright film, chest X-ray; CT of chest/abdomen/pelvis; abdominal ultrasound; bone marrow aspirate/biopsy

Treatment

• Depends on specific etiology
• Respiratory and hemodynamic stability of the patient must be secured before any evaluation or treatment
• Prompt involvement of a pediatric surgeon, neurosurgeon, oncologist, urologist/urologic surgeon, gynecologist, or gastroenterologist will help streamline the approach

Book Source Details

• Book Title: In A Page: Pediatric Signs and Symptoms
• Author(s): Jonathan E. Teitelbaum, Kathleen O. Deantonis, Scott Kahan
• Year of Publication: 2007
• Copyright Details: In A Page: Pediatric Signs and Symptoms, Copyright © 2007 Lippincott Williams & Wilkins.

More About Cholecystitis

• Back to disease: Cholecystitis: Introduction
• Next Book Extract About Cholecystitis: ABDOMINAL MASS, GENERALIZED (Differential Diagnosis in Primary Care)
• More Book Extracts: All Online Books for Cholecystitis

More Medical Textbooks Online about Cholecystitis

Review other book chapters online related to Cholecystitis:

Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.

More About This Book: Title: In A Page: Pediatric Signs and Symptoms Authors: Jonathan E. Teitelbaum, Kathleen O. Deantonis, Scott Kahan Publisher: Lippincott Williams & Wilkins Copyright: 2007 ISBN: 1-4051-0427-9

 » Next page: ABDOMINAL MASS, GENERALIZED (Differential Diagnosis in Primary Care)

Rate This Website

What do you think about the features of this website? Take our user survey and have your say:

Website User Survey

Medical Tools & Articles:

Next articles:

• ABDOMINAL MASS, GENERALIZED (Differential Diagnosis in Primary Care)
• Abdominal mass (Handbook of Signs & Symptoms (Third Edition))
• Abdominal mass (Professional Guide to Signs & Symptoms (Fifth Edition))
• Abdominal/Pelvic Mass (Field Guide to Bedside Diagnosis)
• Cholelithiasis, cholecystitis, and related disorders (Handbook of Diseases)

Tools & Services:

• Bookmark this page
• Symptom Search
• Symptom Checker
• Medical Dictionary
• Give your feedback

Medical Articles:

• Disease & Treatments Search
• Misdiagnosis Center
• Full list of interesting articles

Forums & Message Boards

• Ask or answer a question at the Boards:
• I cannot get a diagnosis. Please help.
• Tell us your medical story.
• Share your misdiagnosis story.
• What is the best treatment for my condition?
• See all the Boards.

Enter your search terms Submit search form
Search The Web Search wrongdiagnosis.com

Common Health Mistakes

Symptom
Checker

Search Specialists by State and City