Abdominal “Masses” in
the infant
Phillip Gordon
Images by :
Univ. of Iowa Virtual Children’s Hospital
Simon C. S. Kao, M.D.
Michael P. D'Alessandro, M.D.,
Steven J. Fishman, M.D.,
Deborah E. Schofield, M.D.
Rainbow Babies & Children's Hospital
Victor Bykov, M.D.
Sheila Berlin, M.D.
Mufaddal Hashim, M.D.
Sheila Berlin, M.D.
Melissa Myers, M.D.
Carlos Sivit, M.D.
Stuart Morrison, M.D.
Dayna Weinert, M.D.
Alan D. Bortz, M.D.
Carlos J. Sivit, M.D.
Sheila C. Berlin, M.D.
Vincent Keiser, M.D.
New England Journal of Medicine
Case Archives
Common Abdominal “Masses” in the Newborn
Retroperitoneal Masses
65%
Polycystic kidneys, hydronephrosis, dysplastic kidneys, neoplasms,
other
GI “Masses”
25%
Things that cause Obstruction, hepatic masses, other
Genito-sacral
10%
Teratomas, congenital genital anomalies, ovarian cysts, other
“This what I was taught, therefore it is what I will teach to you.
However, I know of no convincing evidence that it is actually true or
relevant to our current medical era.”
PVG
Retroperitoneal “Masses” in
the infant
Presentation:
A term male infant is noted to have a firm and
full right flank region during the newborn
exam. The examiner is unable to palpate the
pole of the kidney on the right, but does so
easily on the left. The child’s eyes seem a little
dilated and there is a mild hypospadias, but
the remainder of the exam is otherwise
normal.
Labs:
An electrolyte panel is notable for a serum
creatinine of 1.1 and a BUN of 15.
Wilms Tumor
Presentation:
A term male infant is noted to have a large
and nodular mass in the right flank region
during the newborn exam that ballots as if it
were a kidney. The left kidney is normal upon
palpation.There is a small hemangioma on the
infant’s nape. The remainder of the exam is
otherwise normal.
Labs:
An electrolyte panel is notable for a serum
creatinine of 1.1 and a BUN of 15.
Hydronephrosis secondary to ureteropelvic junction obstruction
(also called a multicystic dysplastic kidney)
Presentation:
A 7 month old male infant is noted to have
unusual weight gain, pustular acne, pubic hair
and a palpable mass on the right flank.
Labs:
An electrolyte panel is notable for a serum
creatinine of 1.1 and a BUN of 15. LFTs are
high normal.
He eyes you suspiciously.
Congenital Cushing Syndrome secondary to adrenal adenoma
Abdominal “Masses” that fill
the entire abdominal cavity
Presentation:
A term male infant is noted to be edematous,
tachypneic and to have a gallop with a HR of 160 bpm.
Perfusion is sluggish but blood pressures and
saturations are normal. The abdomen is distended and
tense. Bowel sounds are present. The kidneys are
palpable.The liver is large. There is a large subdermal
hemangioma on the infant’s nape and smaller one on
the left eyelid. The remainder of the exam is deferred
because of the need to resuscitate (the infant
becomes apneic during the exam).
Labs:
An electrolyte panel is notable for a serum creatinine
of 1.1 and a BUN of 15. LFTs are moderately elevated.
Infantile Hemangioendothelioma
Presentation:
An SGA term male infant is found to be in
respiratory distress secondary to an abdomen that
is extremely distended and tense. Bowel sounds
are absent. The kidneys are not palpable. The
remainder of the exam has to be deferred
because of the need to resuscitate (the infant
becomes apneic during the exam).
Labs:
An electrolyte panel is notable for a serum
creatinine of 1.1 and a BUN of 15. LFTs are
moderately elevated.
mesoblastic nephroma
Presentation:
An LGA 34 week gestation male infant of a diabetic
mother is found to have an abdomen that is
distended and tense on the 3rd day of life. Bowel
sounds are present. The kidneys are palpable. The
infant has been feeding sluggishly. The liver is
difficult to palpitate due to the distention. Perfusion
is good. Color is good. The child has not stooled.
Labs:
An electrolyte panel is notable for a serum
creatinine of 1.1 and a BUN of 32. LFTs are normal.
Meconium plug (“small left colon”) syndrome.
Midline Abdominal “Masses” in
the newborn
Presentation:
An SGA 36 week gestation female infant of a mother
with an anxiety disorder is born at an outside hospital
and noted to have a distended abdomen at birth. The
infant eats well but has had nothing but black liquid
stools over the 1st 3 days of life. A KUB was read by
an adult radiologist, who reported a radio-opaque,
mid-line mass in the lower abdomen. The transferring
doctor reports that, other than the distended
abdomen, the child’s exam is normal.
Labs:
An electrolyte panel is notable for a serum creatinine
of 0.9 and a BUN of 15. LFTs are normal.
Cloacal Malformation / Caudal Regression Syndrome
Presentation:
A term female infant of a mother with an anxiety
disorder is born at an outside hospital and noted to
have an intermittently distended abdomen (thought to
be related to agitation during unsuccessful attempts at
breast feeding). 3 weeks later, the now formula fed
infant eats well but has had alternating diarrhea and
constipation. The transferring ER doctor reports that,
other than the persistently distended abdomen, the
child’s exam is normal.
Labs:
An electrolyte panel is notable for a serum creatinine
of 0.8 and a BUN of 42. LFTs are normal.
duplication cyst of ileocecal junction
LUQ Abdominal “Masses” in
the newborn
(3 Cases with the same presentation)
Presentation (for the next 3 cases):
A term female is noted to have a distended abdomen
with a large, tender viscous mass in the LUQ at birth.
Other pertinent findings include persistent agitation,
skin mottling, a cap refill of 2 seconds and “projectile”
vomiting during the first feed. The infant has a worried
look on its face.
Labs:
An electrolyte panel is notable for a serum creatinine
of 1.1 and a BUN of 18.
Jejunal Web
Malrotation and Midgut Volvulus
Duodenal Atresia
Sacral-coccygeal “Masses” in
the newborn
Presentation:
A term infant is born by c-section due to evidence
of a sacral mass on ultrasound. On initial exam, a
lobular, fully epithelialized, doughy protrusion is
attached to the sacral-lumbar region of an
otherwise normal infant. The infant is tachycardic
(200 bpms) but hemodynamically stable. An x-ray
reveals no bone or dental elements within the
external portions of the mass.
Labs:
An electrolyte panel is notable for a serum
creatinine of 1.1 and a BUN of 18.
THE END
Sacral-coccygeal teratoma (with predominantly neural elements)