Abdominal Masses in the Neonatal Period

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History Gathering
Oligo or polyhydraminos

Full-term

Prenatal US, amniocentesis, pigtail catheter

Family history

Physical Exam
Supine : shape, umbilicus, hernias

Mass: location, size, shape, texture, mobility, tenderness, solid, cystic, air filler

If distension attempt to relieve to improve exam: NG for obstruction, Crede cath for urinary retention

+/- rectal exam

other: chest hypoplasia (Potter’s), bulging hymen (hydrometrocolpos), skin (neuroblastoma)

Differential by location

http://www.raems.com/abdopelvicart.htm

Flank Mass

Renal 55%
Hydronephrosis (most common)
 Unilateral: UPJ or UVJ obstruction, aberrant renal artery, kink in ureter

Bilateral: bladder outlet obstruction (posterior valves or neurogenic bladder) dx: renal scintigraphy and
voiding cystourethrogram

Tx: pyeloplasty, resect obstruction

Note: sever hydro can be detected in utero and treated with a uretero-amniotic shunt

Multicystic Kidney
Unilateral: multicystic dysplastic kidney

Bilateral
Autosomal recessive polycystic kidney, tx: dialysis, transplant

Autosomal dominant polycystic kidney presents later

Solid kidney tumor

Most likely mesoblastic nephroma (benign), concentric rings on US, resect

Wilm’s tumor rarely presents before 6m

Juxtarenal
Neuroblastoma; most common extracranial malignancy in early childhood, solid, fixed, retroperitoneal
(adrenals), catecholamines (sweating, flushing)
Check urine homovanillic acid, vanillyl mandelic acid

AXR, US, CT (staging), bone marrow aspiration (look for bone mets)

Resection +/- chemo and radiation

Good prognostic factors: less than 1yo, stage, histology

4S: stage 1-2 with dissemination to liver, skin (blueberry muffin spots), bone marrow; low risk

http://medicalpicturesinfo.com/wp-content/uploads/2011/09/Neuroblastoma-...

Adrenal hemorrhage – rare, asymptomatic, no management required

Renal Vein Thrombosis – rare, hematuria, HTN, thrombocytopenia, US, anticoagulation only if bilateral or
extending to IVC

Pulmonary Sequestration

Right Upper Quadrant

Liver and biliary tree
Hemangioendothelioma (aka infantile hepatic hemangioma) - +/- cutaneous hemangiomas, can by
asymptomatic or cause AV shunting and CHF, can spontaneously regress
Part of Kasabach-Merritt syndrome: low platlets, consumptive coagulopathy, hemolytic anemia

Treat with steroids, IFN, embolization/resection, or transplant

Hepatoblastoma
Elevated AFP, associated with Beckwith Wiedermann (macrosomia, macroglossia, visceromegaly,
omphalocele)

Resect, +/- neoadjuvant chemo

Hamartoma
Benign but associated with chromosomal abnl

Choledochal cyst – cystic dilation of bile ducts, asymptomatic or jaundice, resection and drainage of hepatic duct
into intestine
Left Upper Quadrant
Splenic cyst – resect if large

Mid Abdomen
Intestinal
Pyloric stenois – “olive”, non-bilious emesis, pyloromyotomy

Intestinal duplication – cystic or tubular, communicating or non-communicating, often no symptoms but can
cause pain, obstruction, bleed, volvulus
Muscular ring on US, resect

Wave-like motion across the abdomen after feeding and before vomiting is typical of PS
- https://survivinginfantsurgery.wordpress.com/tag/reflux/

Intestinal lymphatic malformation (omental, retroperitoneal, mesenteric) – mobile mass, benign but can cause
obstruction, resect

Meconium
Ileus – associated with CF, small bowel atresia

Plug

Obstruction of prematurity

Peritonitis or pseudocyst (if perforation occurs)

Present as distention, doughy mass, ground glass on AXR

Water soluble contrast enema can be diagnostic and therapeutic

Mid Abdominal Wall

Fascial defects causing sub-cutaneous mass

Omphalocele and gastroschisis are not “masses” technically

Omphalomesenteric remanents: incomplete vitelline duct reabsorption

Meckles, omphalomesenteric sinus, cyst, fistula

Surgical repair

Pelvic
Uterine
hydrocolpos, hydrometrocolpos, imperforate hymen, vaginal transverse septum or atresia (block secretions
caused by placental hormones)

Ovarian
Cystic tumors – mobile, usually benign, if complex on US get markers, large cysts need to be excised or
percutaneously drained

Urachal cyst – the allantois remains and there is a connection between umbilicus and bladder – urine out
umbilicus or a cyst

Teratoma – can cause hemorrhage, polyhydraminos, posterior perineal mass: surgery +/- chemo

Hernias and hydrocele

Inguinal – can incarcerate or strangulate, surgery

Hydrocele – observe 1 year

 Groin mass
Girls: entrapped ovary

Boys: ectopic testicle

“The Neonate with an Abdominal Mass” JC Chandler MWL Gauderer, Pediatr Clin Nam 51(2004) 979-997