Pediatric emergency medicine trisk 3784 3784

The presacral sacrococcygeal teratoma is the most common tumor of the caudal
region in children and is more common in females than in males (4:1). Most
tumors are benign and are noted at birth. Tumors in patients beyond neonatal age
have a higher incidence of malignancy. Radiography shows a soft tissue mass that
arises from the ventral surface of the coccyx. Calcifications are present in 60% of
presacral sacrococcygeal teratoma and are more common in benign tumors. US
confirms whether presacral sacrococcygeal teratomas are cystic, solid, or mixed
and can also determine impingement on the urinary tract. CT or MRI are helpful
in confirming the diagnosis, particularly in older children, and demonstrates the
content of a tumor, as well as its extent and bone anomalies. Tumors with more
solid components are more often malignant than those with more cystic
components ( Fig. 116.21 ).

FIGURE 116.21 Presacral teratoma. Computed tomographic section of pelvis with contrast
medium enhancement shows a large cystic mass (arrows ). The mass contains both fat and
calcification, and displaces the rectum anteriorly and laterally, and the bladder anteriorly. B,
Bladder with Foley catheter; C, calcification; F, fat; R, rectum.

Nonmalignant Intra-Abdominal Masses
Fecaloma