1. Neonatal Abdominal Masses

2. 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

3. 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

4. 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

5. 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

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

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

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

9. Toddlers and young children

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

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

12. Older children and teens

13. 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

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

15. 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

16. Inflammatory masses

17. 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

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

19. Head and neck masses

20. 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

21. 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

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

23. Scalp

24. 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

25. 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

26. 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

27. 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

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

29. FACE

30. 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

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

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

33. 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

34. 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

35. 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