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Abdominal masses in infants and children are most commonly incidental in nature and discovered by palpation by a family member or physician. Some abdominal masses are diagnosed by prenatal sonography. Although the majority of these masses are benign and represent organomegaly, there are serious and life-threatening diagnoses that require prompt diagnosis and treatment. The underlying causes of abdominal masses in the pediatric population include vascular, infectious, inflammatory, neoplastic, and congenital. Table 383-1 lists possible diagnoses by location of origin and age group.
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CLINICAL MANIFESTATIONS
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Because neonates and young children are unable to communicate effectively and abdominal masses are most often asymptomatic, a history regarding the mass may be difficult to obtain. The patient’s age is 1 of the most critical factors to narrow the differential diagnosis, as abdominal masses have different etiologies in neonates and infants/children (Table 383-1). Other important information includes birth history, duration, and changes in bowel and bladder habits. Weight loss, jaundice, fever, trauma, recent travel, and sick contacts are also keys to narrowing the differential diagnosis. The location of the mass, size, mobility, consistency, and presence or absence of tenderness and guarding are most important to assess during abdominal examination. Percussion can help detect the components of the mass. Solid and fluid-filled structures are dull, whereas air-filled structures are tympanic. A thorough genital examination is also necessary. Patient age, history, and physical examination findings can narrow the possible diagnoses significantly prior to undertaking further diagnostic evaluation.
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DIAGNOSTIC EVALUATION
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The first imaging study performed for a suspected ...