Paediatrics: Abdominal/renal mass

2021-03-04 12:00 AM

A rare presentation of urinary tract problems, which needs to be differentiated from other causes of abdominal mass and swelling.

Abdominal/renal mass

A rare presentation of urinary tract problems, which needs to be differentiated from other causes of abdominal mass and swelling.

Causes

Intrarenal

  • Wilms’ tumour (young child with rapidly growing mass).
  • Renal venous thrombosis (newborn with haematuria).
  • Benign nephroma (rare neonatal problem).
  • Horseshoe kidney.
  • Pyelonephritis (renal abscess).

Other renal

Hydronephrosis associated with the following.

  • Pelviureteric junction (PUJ) obstruction.
  • Vescioureteric junction (VUJ) obstruction.
  • Large bladder and bladder outlet obstruction: e.g.

o posterior urethral valves (PUV);

o prune belly syndrome;

o neurogenic bladder.

  • Urinoma: i.e. an encapsulated extra pelvicalyceal collection of urine that forms from urine leakage through a tear in the collecting system or the proximal ureter.
  • A single cyst (benign renal cyst).
  • Multicystic dysplastic kidney—usually newborn.
  • Polycystic disease:

o autosomal recessive;

o autosomal dominant—rare in children.

  • Haematoma (trauma).

Extrarenal

Adrenal mass (e.g. neuroblastoma).

Investigation

  • US will distinguish between most of the above.
  • Further investigation, depending on likely causes and discussion with radiology and urology colleagues, e.g. CT, MRI.