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Pediatric Abdominal Masses
Pediatric Abdominal Masses
MASSES
1-Abdominal masses are common in infants and children,
2- and imaging plays an important role in their diagnosis
and management.
3-Plain radiographs provide clues to the location of the
mass and the presence of calcifications.
4-US is generally the most valuable procedure for the
initial evaluation.
5-US differentiates cystic from solid masses, indicates the
organ of origin, and commonly suggests the diagnosis.
6- CT or MR may be needed when the mass is large,
poorly defined, or obscured by bowel gas.
1-Pseudomasses may be caused on
abdominal radiographs by a fluid-filled
stomach, urinary bladder, or a loop of
intestine.
2-Structures outside the abdomen, such as
large skin lesions, umbilical hernias, and
meningomyelocele, can also mimic an
abdominal mass.
3-The most common abdominal masses in
infants and children are enlarged kidneys
caused by hydronephrosis or cystic renal
disease.
Renal and Adrenal Masses
Large Kidneys
1-Unilateral enlargement of a kidney results from
hydronephrosis, multicystic dysplastic kidney, renal vein
thrombosis, or renal tumors .
2-Bilateral renal enlargement can be seen with
hydronephrosis, polycystic kidney disease, storage
diseases, and glomerulonephropathies, including nephrotic
syndrome.
3- Bilateral renal enlargement caused by neoplasms is less
common, although leukemia or lymphoma may infiltrate
the renal parenchyma bilaterally
Nephroblastomatosis
1-Small islands of primitive metanephric blastema,
which are thought to be a precursor of Wilms tumor,
commonly exist in the kidneys of the normal newborn
infant.
2- These primitive cells usually spontaneously regress
by 4 months of age.
3- A diffuse and proliferative form of persistent renal
blastoma is referred to as nephroblastomatosis.
The abnormal tissue can form as multiple discrete
nodules within the renal parenchyma or may
completely replace the renal cortex. -
Nephroblastomatosis appears on CT or IV pyelogram
as bilateral lobulated and enlarged kidneys with
marked compression, stretching, and distortion of the
pelvicaliceal structures
FIGURE 52.55. Nephroblastomatosis. A. The kidneys are
massively enlarged, with lobulated thickening of the
parenchyma and stretching and compression of the
collecting structures. B. T1WI in another patient shows
multiple peripheral Wilms tumors (arrows) in a child with
nephroblastomatosis.
On US, the kidneys are enlarged, lobular, and
bile duct below the cystic duct. Choledochal cysts are usually
diagnosed by US, appearing as a cystic mass in the porta
hepatis, separate from the gallbladder and associated with
dilated intrahepatic ducts Hepatobiliary scintigraphy confirms
that the cyst communicates with the biliary tract, aiding in
differentiation from other cystic abdominal masses MR
cholangiopancreatography may provide more detailed
information about bile duct anatomy and anatomic
relationships to adjacent structures
FIGURE 52.62. Choledochal Cyst. A. US shows a large, multilobulated anechoic cyst (C)
that is adjacent to, but separate from, the gallbladder (arrows). B. Cholangiography
confirms the presence of a large intrahepatic choledochal cyst (arrows) involving the
right hepatic duct. GB, gallbladder. C. CT scan of a different child shows a well-defined
cyst in the porta hepatis (arrow) associated with dilated central hepatic ducts
Hepatic cysts are less common in infants and children
than in adults. Solitary congenital cysts of the liver are
usually encountered as an incidental finding at US or
CT. The cyst walls are thin and the fluid is anechoic
on US. Some cysts are very large and pedunculated,
and their hepatic origin may be difficult to ascertain.
Multiple hepatic cysts occur in patients with
autosomal dominant polycystic disease. Acquired
hepatic cysts may be solitary or multiple and are most
commonly of infectious origin (Fig. 52.63). Resolving
hematoma of the liver may also appear as a well-
defined cystic lesion
FIGURE 52.63. Candida Abscess of the Liver. Two
irregular cystic collections with peripheral echogenicity
are liver abscesses in this newborn infant with Candida
sepsis
Hemangioendothelioma is the most common benign liver tumor
encountered in infancy . This vascular lesion may be solitary or
multiple and is associated with cutaneous hemangiomas in 40% of
cases. Hemangioendothelioma may be complicated by high-
output cardiac failure,