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BACKGROUND

Although evaluation of an abdominal mass often occurs in an outpatient setting, pediatric hospitalists are often asked to expedite the initial assessment and coordinate the appropriate consultations. The diagnostic possibilities vary considerably, based on the patient’s age and associated symptoms. The most urgent considerations are acute surgical conditions and neoplasms. A careful history and physical examination should guide a directed laboratory and imaging evaluation, leading to the diagnosis.

PATHOPHYSIOLOGY

There are many structures within the abdomen from which masses can arise (Table 16-1). Abdominal masses can represent abnormal tissue mass of a solid organ such as the liver, spleen, or kidney or abnormal filling of a viscous organ such as the bowel or bladder. The most common source of an abdominal mass besides constipation is kidney pathology.

TABLE 16-1Possible Diagnoses of Abdominal Masses

HISTORY

Abdominal masses present in two distinct ways: painless or with abdominal symptoms. A painless mass is the classic sign of abdominal malignancy, particularly Wilms tumor and neuroblastoma. However, painless masses may also be completely benign, such as a fecal mass in a constipated child, a horseshoe kidney, or a wandering spleen. Painless masses are usually identified incidentally, often by parents when bathing the child, and sometimes on routine physical examinations. Systemic symptoms such as weight loss, pallor, bruising, or bleeding are suggestive of a malignant process. Diarrhea can be a sign of a vasoactive secreting tumor, while hematuria strongly suggests renal involvement. Masses may cause or be the result of GI obstruction and can present with vomiting, abdominal pain, and constipation. Masses that are renal in origin can present with symptoms of urinary dysfunction and hematuria. Painful masses require an evaluation for possible urgent intervention for ischemic diseases like ovarian torsion or intussusception or the need for decompression of the bowel or bladder. Duration ...

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