NEONATAL ABDOMINAL MASSES
NEONATES

75-80%
 Benign

genitourinary lesions
Most common
 Congenital
obstructive
hydronephrosis
 Multicystic dysplastic kidney
Bulky and smooth
 Flank

NEONATES

GU masses
 Ureteral
duplications
and Ureteroceles
 May
produce obstructive
uropathies that lead to
palpable masses
 PUV
 Bilateral
flank masses
 Most common cause of
distal urinary tract
obstruction in boys
NEONATES

Mulitcystic dysplastic
kidney


Renal vein thrombosis



Unilateral, soft, cystic
Hyperviscocity
syndromes
Severe neonatal
dehydration
Mesoblastic nephroma


Benign renal tumor
Mimics Wilms
NEONATES

Ovarian cysts



Maternal hormone
stimulation
Withdrawal leads to
resolution
>5cm at risk for torsion



Should be aspirated
Congenital vaginal
obstruction
GI duplication cysts

Diagnosis often made
later
NEONATES

Mesenteric and
omental cysts
 Soft,
diffuse and
multiloculated
 Due to congenital
lymphatic obstruction
 May have acute
hemorrhage
 Acute
abdominal pain
NEONATES

Adrenal masses
 Common
 Benign
 Spontaneous
adrenal
hemorrhage
Perinatal stress
 Birth trauma

 Neuroblastoma
 Malignant
NEONATES

Intra-abdominal extra
lobar sequestration
Adjacent to adrenal
gland
 Suggests a malignancy


Sacrococcygeal
teratoma

Most common
malignancy of infancy
TODDLERS AND YOUNG CHILDREN
HEPATIC LESIONS
Bulky RUQ mass
 Fixed
 Benign

 Hemangioendothelioma
 AVM
 Mesenchymal
hamartoma
 Choledochal cysts
SPLENIC LESIONS

Underlying
hematologic disease
 Immunodeficiency
 Lymphoproliferation

Splenic cysts
 Congenital
 Trauma
OLDER CHILDREN AND TEENS
QUESTION 7
A premenstral 12 yo F presents to
clinic with a history of abdominal
pain occuring once a month. The
abnormal physical exam finding is
pictured. What other abnormalities
is this patient at risk for?
A.
B.
C.
D.
E.
GU
Cardiac
Brain
GI
Limb
OVARIAN MASSES
Mostly seen in adolescence
 >75% benign

 Cystic

25%
 Solid
 Malignant
changes
VAGINAL OBSTRUCTION

Puberty
Cyclic abdominal pain
 Large pelvic or lower
abdominal mass
 Absence of menses
 May have
hydronephrosis

 Obstruction
 Coexisting
GU
abnormalities

Newborns

Hydrocolpos
INFLAMMATORY MASSES
INFLAMMATORY MASSES

Characteristics
Tender
 Systemic symptoms
 Persistent signs of sepsis


Causes
Bowel perforations
 Meckel diverticulitis
 Crohns
 VP shunts


Omentum and adjacent bowel loops migrate to
localize the process and an abscess cavity forms
INFLAMMATORY MASSES

Treatment
IV antibiotics
 Percutaneous drainage


Crohns

Fistula
 Failure
to respond to
medical therapy
Upper GI with SBFT
 BE

HEAD AND NECK MASSES
HEAD AND NECK
Most lesions are benign
 Critical PE findings

 Determination
of size
 Evidence of airway compromise
 Signs of inflammation
 Presence of sinus tracts
 Ocular involvement
HEAD AND NECK

Radiology
 CT
or MRI
 Bony
structures
 Vascular structures
 Brain involvement

Endoscopic procedures
 Nasopharyngoscopy,
laryngoscopy and
esophagoscopy
 Disorders of breathing, swallowing or phonation
HEAD AND NECK

Surgery
 Frequently
necessary for diagnosis and therapy
 Unnecessary cases
 Hemangioma
 Torticollis
 Benign
reactive adenopathy
SCALP
QUESTION 8
The parents of a 1 month old M infant are concerned
about a red lesion that has appeared on his upper
forehead. On exam, it appears to be a small 1cm
hemangioma. What do you tell them?
A. This child needs referral to a dermatologist for
medical treatment
B. The lesion is benign and will resolve during the first 7
years of life
C. Surgical intervention is necessary because it is on
the face
D. The lesion is unlikely to resolve on its own
E. This lesion has a high malignant potential
SCALP

Hemangiomas



Benign, congenital
vascular tumors
Most frequent in head and
neck
Characteristics
Raised
 Red or purple
 May blanch


May not be present at birth

Develop in the first few
months of life
SCALP

Hemangiomas

Kasabach-Merritt
Syndrome
 Due
to rapid growth and
expansion
 Platelet sequestration
 Coagulopathy
 Refractory to treatment

Typical course
 Benign
 Spontaneous
resolution over
first 7 years
 Surgical intervention


Airway compromise
Periorbital involvement
DERMOID CYSTS
Congenital lesions
 Composed of

Hair
 Skin
 Sebaceous structures

Occur in areas of embryonic
fusion
 Most frequent in head and
neck


Also found in sacral, perineal
and sternal region
DERMOID CYSTS

Characteristics
Well-circumscribed
 Firm
 Fixed to deep structures

Always evaluate by MRI
before surgical
intervention for
extention
 Treatment is surgical

FACE
FACE

Preauricular skin tags
Vestigial cartilaginous remnants
 Cosmetic


Preauricular pits or sinuses
Prone to infectious complications
 Epidermal inclusion structures
 Most lesions asymptomatic
 Surgical resections for infectious
complications

FACE

Parotid Gland
 Hemangiomas
 Viral
 Mumps
 Bacterial
 Staphylococcal
 Mycobacterial
 Atypicals
 Chronic
or TB
inflammatory conditions
FACE

Intraoral lesions
 Ankyloglossia
inferior
 Tongue-tie
 Usually
resolves
spontaneously

Regresses with feeding
 Speech
problems if
persistent
 Treatment

Simple division
FACE

Ranula
Pseudocysts in the floor of
the mouth
 May spontaneously resolve
 Few become large

 Impairs
lingual mobility
 Impairs speech
 Impairs breathing

Treatment
 Marsupialization
excision
or complete
FACE

Lymphangiomas
May cause obstruction if
mouth involved
 Smaller, vesicular
lesions located on the
tongue may exude fluid
that becomes purulent

 May

need antibiotics
Treatment
 Possible
partial
glossectomy
 Speech development,
mandibular growth
FACE

Lingual thyroid
Rare developmental anomaly of the thyroid
 Failure of thyroid descent

 Located

at the base of the tongue (foramen cecum)
Presentation
 Acute
airway obstruction
 Lump in the throat on
swallowing
 Hypothyroidism

Treatment
 Thyroid
replacement
 Surgical excision if
obstructive