Lim GT, Teh YG, Ng CY, Mohd Khalid H, Hayati F. Case report: Ballotable abdominal mass in a child - Definitely renal in origin?
Ann Med Surg (Lond) 2021;
62:84-87. [PMID:
33505677 PMCID:
PMC7815487 DOI:
10.1016/j.amsu.2021.01.003]
[Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Revised: 01/03/2021] [Accepted: 01/03/2021] [Indexed: 12/22/2022] Open
Abstract
Introduction and importance
The differential diagnosis of a paediatric abdominal mass can be extensive, as it potentially involves multiple organs including gastrointestinal, genitourinary, endocrine, and gynaecological systems. Hence, a systematic approach to history taking and physical examination is needed to clinch the diagnosis. Specifically, the approach for assessing, investigating, and managing a ballotable left hypochondrial mass in a child can be challenging.
Case presentation
We report a 10-year-old Dusun girl presenting with left hypochondrial pain and noted a left hypochondrial mass on examination. This report highlights the role of clinical imaging during the pre-operative and post-operative phases.
Clinical discussion
Ultrasound and CT imaging was useful in determining that the tumor originated from the tail of the pancreas. The presence of a definite capsule with internal solid-cystic components helped narrowed the differential diagnosis to solid pseudopapillary neoplasm (SPN) of the pancreas. MR liver was useful to rule out liver metastasis in this child.
Intervention and outcome
The patient was scheduled for laparotomy and tumour excision at a regional paediatric centre. Successful excision of the tumor en-mass was performed and the child's subsequent recovery was uneventful.
Conclusion
Clinical imaging plays a critical role in the diagnosis and management of paediatric solid organ tumours. Other than renal origin, suspicion of pancreatic tail origin should be considered by clinicians when encountering a ballotable left abdominal mass.
A mass arising from the pancreatic tail can present as a ballotable mass.
Imaging findings for solid pseudopapillary neoplasm and differentials are presented.
The role of imaging in the management of solid pseudopapillary neoplasm is discussed.
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