Neonatal Abdominal Masses

1. Neonatal Abdominal Masses

2. 75-80% • Benign genitourinary lesions • Most common • Congenital obstructive hydronephrosis • Multicystic dysplastic kidney • Bulky and smooth • Flank Neonates

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

4. Mulitcystic dysplastic kidney • Unilateral, soft, cystic • Renal vein thrombosis • Hyperviscocity syndromes • Severe neonatal dehydration • Mesoblasticnephroma • Benign renal tumor • Mimics Wilms Neonates

5. Ovarian cysts • 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

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

7. Adrenal masses • Common • Benign • Spontaneous adrenal hemorrhage • Perinatal stress • Birth trauma • Neuroblastoma • Malignant Neonates

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

9. Toddlers and young children

10. Bulky RUQ mass • Fixed • Benign • Hemangioendothelioma • AVM • Mesenchymalhamartoma • Choledochal cysts Hepatic Lesions

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

12. Older children and teens

13. 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 Question 7

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

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

16. Inflammatory masses

17. Characteristics • 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

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

19. Head and neck masses

20. 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

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

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

23. Scalp

24. 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 Question 8

25. 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

26. Hemangiomas • Kasabach-Merritt Syndrome • 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 Scalp

27. 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

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

29. FACE

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

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

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

33. 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

34. 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

35. 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 Face