Pediatric emergency medicine trisk 2560 2560

treatment is to recognize the abdominal mass that requires urgent evaluation and
treatment.
CLINICAL PEARLS AND PITFALLS
Two-thirds of abdominal masses in the neonate are renal in origin.
Infants with suspected renal masses should be monitored for
hypertension.
Renal Masses
Renal lesions are the most common causes of abdominal masses in the neonate.
Cystic masses typically represent hydronephrosis, multicystic dysplasia, or
polycystic disease. Solid masses include renal vein thrombosis, renal ectopic
kidney, or horseshoe kidney. Rarely, renal masses may represent malignant
disease such as mesoblastic nephroma or Wilms tumor. Depending on the size of
the mass, some infants may develop feeding intolerance or respiratory distress in
the setting of profound abdominal distention. Infants with renal masses should be
monitored closely for hypertension, as most causes of hypertension in the neonate
are renal in origin. Evaluation should include US to distinguish cystic from solid
lesions, as well as serum testing for renal function evaluation. Infants with
hydronephrosis may also require voiding cystourethrogram to assess for
comorbid VUR.
Hepatic Masses
Hepatic masses in the neonate are extraordinarily rare, and can represent
significant pathology. Masses may include congenital hemangiomas, hepatic
mesenchymal hamartomas, hemangioendotheliomas, or hepatoblastoma. Because
of the vascular nature of the liver and the relative immaturity of the hepatic
capsule, rapidly enlarging or vascular lesions are prone to bleeding, which when
present can result in significant hemorrhage. This can result in severe anemia and
heart failure, as well as thrombocytopenia caused by consumptive coagulopathy.
Patients with palpable hepatic masses should undergo additional diagnostic
testing with US, as well as serum testing for complete blood count, liver function
tests, coagulation studies, and alpha-fetoprotein.
Adrenal Masses

Suprarenal masses most often represent adrenal hemorrhage, but can also
represent adrenal neuroblastoma or teratoma. Subclinical adrenal hemorrhage is