Abdominal Masses

Nicholas M. Potisek; James W. Antoon

doi:10.1542/pir.2016-0087

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Nicholas M. Potisek, MD*
James W. Antoon, MD, PhD^†

^*Wake Forest School of Medicine, Winston-Salem, NC
^†Children's Hospital, University of Illinois Hospital & Health Sciences System, Chicago, IL

Suggested Reading

An Approach to Renal Masses in Pediatrics. Malkan AD, Loh A, Bahrami A, et al. Pediatrics. 2015;135(1):142–158
OpenUrl Abstract/FREE Full Text
Current Imaging Assessment of Congenital Abdominal Masses in Pediatric Patients. Crane GL, Hernanz-Schulman M. Semin Roentgenol. 2012;47(1):32–44
OpenUrl PubMed
Pediatrics: Diagnosis of Neuroblastoma. Sharp SE, Gelfand MJ, Shulkin BL. Semin Nucl Med. 2011;41(5):345–353
OpenUrl CrossRef PubMed

AUTHOR DISCLOSURE
Drs Potisek and Antoon have disclosed no financial relationships relevant to this article. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device.

Finding an abdominal mass on a child can be alarming to both the parents and pediatrician. Abdominal masses are often incidentally discovered by a parent while bathing the child, palpated unexpectedly on routine physical examination, or detected on abdominal imaging. The causes of pediatric abdominal masses are extensive, ranging from benign to neoplastic, and often originating from organs within the intra-abdominal cavity (Table).

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Table.

Causes of Pediatric Abdominal Masses

At presentation, patients may be asymptomatic or report a wide range of associated symptoms, including fever, hematuria, and abdominal pain or distension. New-onset hypertension may be the first sign of an abdominal mass. The child’s age, associated symptoms, location of mass, and laboratory findings provide important clues to the underlying cause and can direct appropriate evaluation and consultation.

Most abdominal masses in infants originate from the kidney and are benign. Often discovered prenatally, hydronephrosis, the most common renal mass in infants, is typically unilateral and results from vesicoureteral reflux and/or obstruction at the ureteropelvic junction. Multicystic dysplastic kidneys are another cause of hydronephrosis described as numerous noncommunicating cysts that vary in size, with little to no normal renal tissue identified. Bilateral renal masses detected on examination or imaging are concerning for autosomal recessive polycystic kidney disease (ARPKD). The presentation of ARPKD varies with the degree of hyperplasia of the collecting tubules and may be detected in utero or later in childhood.

The most common renal neoplasm in infants is congenital mesoblastic nephroma (CMN), …