Solid Abdominal Mass
Paula J. Woodward, MD
DIFFERENTIAL DIAGNOSIS
Common
Bronchopulmonary Sequestration
Mesoblastic Nephroma
Less Common
Neuroblastoma
Rare but Important
Fetus-in-Fetu, Teratoma
Liver Tumors
ESSENTIAL INFORMATION
Key Differential Diagnosis Issues
Key to diagnosis is careful anatomic survey to determine origin
Kidney, adrenal, liver, not within a defined organ
Color Doppler assessment important
Patterns of perfusion are different
Solid masses often have increased vascularity that can result in arteriovenous shunting & hydrops
Helpful Clues for Common Diagnoses
Bronchopulmonary Sequestration
10-15% subdiaphragmatic
Majority left-sided, with stomach displaced anteriorly
Typically an echogenic, solid mass, but may see cystic areas
Look for dominant feeding vessel from aorta
Usually presents in 2nd trimester
Mesoblastic Nephroma
Large, solid renal mass
Look for mass being fed by renal artery
Polyhydramnios in ≈ 70%, often severe
Helpful Clues for Less Common Diagnoses
Neuroblastoma
May be solid or cystic
60% on right
Separate from kidney & adrenal
No dominant feeding vessel
Usually not seen until 3rd trimester
Helpful Clues for Rare Diagnoses
Fetus-in-Fetu, Teratoma
Overlapping features between these two entities
Fetus-in-fetu more developed & must have spinal elements
Usually not completely solid
May have large, solid component encapsulated within a cyst
Calcifications, including well-formed bones, most specific finding
Superior mesenteric artery is predominant vascular supply
Liver Tumors
Generally large, causing hepatomegaly & increased abdominal circumference
Hemangioendothelioma most common
Large vessels within mass
Follow carefully for development of hydrops
Hepatoblastoma, leukemic infiltration, & metastases may also appear as solid masses
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