Neonatal Abdominal Masses

Neonates 75-80% Most common Bulky and smooth Flank Benign genitourinary lesions Most common Congenital obstructive hydronephrosis Multicystic dysplastic kidney Bulky and smooth Flank Flank mass due to UPJ obstuction leading to hydronephrosisi

Neonates GU masses Ureteral duplications and Ureteroceles PUV May produce obstructive uropathies that lead to palpable masses PUV Bilateral flank masses Most common cause of distal urinary tract obstruction in boys

Neonates Mulitcystic dysplastic kidney Renal vein thrombosis Unilateral, soft, cystic Renal vein thrombosis Hyperviscocity syndromes Severe neonatal dehydration Mesoblastic nephroma Benign renal tumor Mimics Wilms

Neonates Ovarian cysts Congenital vaginal obstruction Maternal hormone stimulation Withdrawal leads to resolution >5cm at risk for torsion Should be aspirated Congenital vaginal obstruction GI duplication cysts Diagnosis often made later

Neonates Mesenteric and omental cysts Soft, diffuse and multiloculated Due to congenital lymphatic obstruction May have acute hemorrhage Acute abdominal pain

Neonates Adrenal masses Common Benign Malignant Spontaneous adrenal hemorrhage Perinatal stress Birth trauma Neuroblastoma Malignant Left suprarenal heterogeneous mass suspicious for neuroblastoma

Neonates Intra-abdominal extra lobar sequestration Adjacent to adrenal gland Suggests a malignancy Sacrococcygeal teratoma Most common malignancy of infancy

Toddlers and young children

Hepatic Lesions Bulky RUQ mass Fixed Benign Hemangioendothelioma AVM Mesenchymal hamartoma Choledochal cysts

Splenic Lesions Underlying hematologic disease Splenic cysts Immunodeficiency Lymphoproliferation Splenic cysts Congenital Trauma

Older children and teens

Question 7 A premenstral 12 yo F presents to clinic with a history of abdominal pain occuring once a month. The abnormal physical exam finding is pictured. What other abnormalities is this patient at risk for? A. GU B. Cardiac C. Brain D. GI E. Limb Answer A

Ovarian Masses Mostly seen in adolescence >75% benign 25% Cystic Solid Malignant changes

Vaginal Obstruction Puberty Newborns Cyclic abdominal pain Large pelvic or lower abdominal mass Absence of menses May have hydronephrosis Obstruction Coexisting GU abnormalities Newborns Hydrocolpos

Inflammatory masses

Inflammatory Masses Characteristics Causes Tender Systemic symptoms Persistent signs of sepsis Causes Bowel perforations Meckel diverticulitis Crohns VP shunts Omentum and adjacent bowel loops migrate to localize the process and an abscess cavity forms

Inflammatory Masses Treatment Crohns IV antibiotics Percutaneous drainage Crohns Fistula Failure to respond to medical therapy Upper GI with SBFT BE

Head and neck masses

Head and Neck Most lesions are benign Critical PE findings Determination of size Evidence of airway compromise Signs of inflammation Presence of sinus tracts Ocular involvement

Head and Neck Radiology Endoscopic procedures CT or MRI Bony structures Vascular structures Brain involvement Endoscopic procedures Nasopharyngoscopy, laryngoscopy and esophagoscopy Disorders of breathing, swallowing or phonation

Head and Neck Surgery Frequently necessary for diagnosis and therapy Unnecessary cases Hemangioma Torticollis Benign reactive adenopathy

Scalp

Question 8 The parents of a 1 month old M infant are concerned about a red lesion that has appeared on his upper forehead. On exam, it appears to be a small 1cm hemangioma. What do you tell them? A. This child needs referral to a dermatologist for medical treatment B. The lesion is benign and will resolve during the first 7 years of life C. Surgical intervention is necessary because it is on the face D. The lesion is unlikely to resolve on its own E. This lesion has a high malignant potential Answer B

Scalp Hemangiomas Benign, congenital vascular tumors Most frequent in head and neck Characteristics Raised Red or purple May blanch May not be present at birth Develop in the first few months of life

Scalp Hemangiomas Kasabach-Merritt Syndrome Typical course Due to rapid growth and expansion Platelet sequestration Coagulopathy Refractory to treatment Typical course Benign Spontaneous resolution over first 7 years Surgical intervention Airway compromise Periorbital involvement

Dermoid Cysts Congenital lesions Composed of Hair Skin Sebaceous structures Occur in areas of embryonic fusion Most frequent in head and neck Also found in sacral, perineal and sternal region

Dermoid Cysts Characteristics Well-circumscribed Firm Fixed to deep structures Always evaluate by MRI before surgical intervention for extention Treatment is surgical

FACE

Face Preauricular skin tags Preauricular pits or sinuses Vestigial cartilaginous remnants Cosmetic Preauricular pits or sinuses Prone to infectious complications Epidermal inclusion structures Most lesions asymptomatic Surgical resections for infectious complications

Face Parotid Gland Hemangiomas Viral Bacterial Mycobacterial Mumps Bacterial Staphylococcal Mycobacterial Atypicals or TB Chronic inflammatory conditions

Face Intraoral lesions Ankyloglossia inferior Tongue-tie Usually resolves spontaneously Regresses with feeding Speech problems if persistent Treatment Simple division

Face Ranula Pseudocysts in the floor of the mouth May spontaneously resolve Few become large Impairs lingual mobility Impairs speech Impairs breathing Treatment Marsupialization or complete excision

Face Lymphangiomas May cause obstruction if mouth involved Smaller, vesicular lesions located on the tongue may exude fluid that becomes purulent May need antibiotics Treatment Possible partial glossectomy Speech development, mandibular growth

Face Lingual thyroid Rare developmental anomaly of the thyroid Failure of thyroid descent Located at the base of the tongue (foramen cecum) Presentation Acute airway obstruction Lump in the throat on swallowing Hypothyroidism Treatment Thyroid replacement Surgical excision if obstructive