Abdominal Mass
Basics
Description
A palpable lesion or fullness in the abdominal cavity which may or may not be related to abdominal viscera or a lesion detected on abdominal imaging; the mass may be abdominal or retroperitoneal in origin.
Epidemiology
- Etiologies for abdominal masses are varied, and the differential depends on age and anatomic location.
- Majority are nonsurgical in nature; may be associated with constipation
- Approximately 57% of abdominal masses in children are due to organomegaly (hepatomegaly or splenomegaly).
- Most abdominal masses in infants originate from the kidney and are benign (e.g., hydronephrosis); Wilms tumor is the most common malignant tumor of the kidney seen in childhood.
- Liver masses account for 5–6% of all pediatric intra-abdominal masses; hepatoblastoma is the most common primary liver tumor in children, often presenting at 1 to 3 years of age.
Risk Factors
- Certain genetic disorders/syndromes are associated with increased risk of tumor development.
- Patients with Beckwith-Wiedemann syndrome; Wilms tumor, aniridia, genitourinary anomalies, and mental retardation (WAGR); and Denys-Drash syndrome are at increased risk of Wilms tumor and require regular screening.
General Prevention
Dependent on whether or not the mass or lesion is related to a modifiable factor (e.g., a retained foreign body requires parental or patient counseling for prevention)
Pathophysiology
Varies based on the type of mass seen
Etiology
- Stomach
- Gastric distension or gastroparesis
- Duplication
- Foreign body or bezoar
- Gastric torsion
- Gastric tumor (lymphoma, sarcoma)
- Intestine
- Feces (constipation)
- Intestinal distension or toxic megacolon
- Foreign body
- Meconium ileus
- Duplication
- Volvulus
- Intussusception
- Intestinal atresia or stenosis
- Malrotation
- Complications of inflammatory bowel disease (abscess, phlegmon)
- Appendiceal inflammation
- Meckel diverticulum or abscess
- Duodenal hematoma (trauma)
- Lymphoma, adenocarcinoma, GI stromal tumor
- Carcinoid (appendiceal)
- Liver
- Hepatomegaly due to intrinsic liver disease
- Hepatitis (e.g., infectious, autoimmune)
- Metabolic or storage disorders (e.g., Wilson disease, glycogen storage disease)
- Infiltration of liver (cyst, tumors)
- Biliary obstruction
- Vascular obstruction/impaired venous congestion (Budd-Chiari syndrome, congestive heart failure)
- Cystic disease (e.g., Caroli disease)
- Solid tumor (hepatoblastoma; hepatocellular carcinoma; hepatic adenoma; or other diffuse, systemic, neoplastic process)
- Vascular tumor (hemangioma or hemangioendothelioma)
- Other: hamartomas, focal nodular hyperplasia
- Hepatomegaly due to intrinsic liver disease
- Gallbladder/biliary tract
- Choledochal cyst
- Hydrops of gallbladder
- Obstruction (stone, stricture, trauma)
- Spleen
- Congenital cysts
- Storage disease (e.g., Gaucher, Niemann-Pick)
- Langerhans cell histiocytosis
- Leukemia
- Hematologic (hemolytic disease [e.g., sickle cell] or other RBC disorders [e.g., hereditary spherocytosis])
- Portal hypertension
- Wandering spleen
- Pancreas
- Congenital cysts
- Pseudocyst (trauma, pancreatitis)
- Pancreatoblastoma
- Neuroendocrine tumors (insulinomas, gastrinomas)
- Solid and papillary epithelial neoplasms
- Kidney
- Hydronephrosis or ureteropelvic obstruction
- Multicystic dysplastic kidney
- Polycystic disease
- Tumor (mesoblastic nephroma, Wilms tumor, renal cell carcinoma)
- Renal vein thrombosis
- Cystic nephroma
- Bladder
- Bladder distension
- Neurogenic bladder
- Adrenal
- Adrenal hemorrhage
- Adrenal abscess
- Neuroblastoma
- Pheochromocytoma
- Uterus
- Pregnancy
- Hematocolpos
- Hydrocolpos or hydrometrocolpos
- Ovary
- Cysts (dermoid, follicular)
- Torsion
- Germ cell tumor
- Peritoneal
- Ascites
- Teratoma
- Abdominal wall
- Umbilical/inguinal/ventral hernia
- Omphalocele/gastroschisis
- Urachal cyst
- Trauma (rectus hematoma)
- Tumor (fibroma, lipoma, rhabdomyosarcoma)
- Omentum/mesentery
- Cysts
- Mesenteric fibromatosis
- Mesenteric adenitis
- Other
- Tumors (liposarcoma, leiomyosarcoma, fibrosarcoma, mesothelioma)
- Intra-abdominal testicle (torsion)
- Lymphangioma
- Fetus in fetu
- Sacrococcygeal teratoma
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Citation
Cabana, Michael D., editor. "Abdominal Mass." 5-Minute Pediatric Consult, 8th ed., Wolters Kluwer, 2019. Pediatrics Central, peds.unboundmedicine.com/pedscentral/view/5-Minute-Pediatric-Consult/617555/all/Abdominal_Mass.
Abdominal Mass. In: Cabana MDM, ed. 5-Minute Pediatric Consult. Wolters Kluwer; 2019. https://peds.unboundmedicine.com/pedscentral/view/5-Minute-Pediatric-Consult/617555/all/Abdominal_Mass. Accessed October 15, 2024.
Abdominal Mass. (2019). In Cabana, M. D. (Ed.), 5-Minute Pediatric Consult (8th ed.). Wolters Kluwer. https://peds.unboundmedicine.com/pedscentral/view/5-Minute-Pediatric-Consult/617555/all/Abdominal_Mass
Abdominal Mass [Internet]. In: Cabana MDM, editors. 5-Minute Pediatric Consult. Wolters Kluwer; 2019. [cited 2024 October 15]. Available from: https://peds.unboundmedicine.com/pedscentral/view/5-Minute-Pediatric-Consult/617555/all/Abdominal_Mass.
* Article titles in AMA citation format should be in sentence-case
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BT - 5-Minute Pediatric Consult
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PB - Wolters Kluwer
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