General Considerations

The suspicion or diagnosis, even if it is nonspecific, of an abdominal mass in a child raises concern and anxiety. The pediatric radiologist may be the first person either to suspect or to diagnose a mass, quite commonly by ultrasonog-raphy (US). Therefore, adequate psychological interaction with the patient and the parent(s) is part of his or her professional competence. The findings should generally not be discussed while the examination is underway. Specific diagnostic statements should be avoided, even by the experienced examiner. Caution should be exercised before giving preliminary histological and prognostic hypotheses. The involved clinician, possibly the oncologist, should be informed promptly about the morphological findings and the information exchanged between the examiner and the patient and/or accompanying parent(s). This regards the situation of a suspicious mass that has been demonstrated and where a malignant process might exist or be likely. If the mass turns out to be a hydronephrosis or a similar obviously benign process, such concerns are less relevant.

Abdominal masses in children are often cystic and almost always benign, especially in the younger child (i.e., newborn and infants). In a majority of these cases, the mass originates from the urinary tract, typically due to some obstructive malformation and/or dysfunction (Fig. 1). Beside neoplasia and malformation, the underlying causes of such masses may be pathological conditions such as inflammation (usually due to infection), trauma (including iatrogenesis) or metabolic or other systemic diseases, including malignancy.

Proper imaging technique includes the correct choice of the imaging tool(s) and, if there is a need for more than one modality, their use in the appropriate order. This will shorten the time to diagnosis, and avoid uncertainty and unnecessary discussion, as well as help to limit costs. The role of the pediatric radiologist, therefore, is not only to make the diagnosis, but he or she also has a consulting duty toward the clinician who might think that, for example, all questions may be answered using magnetic resonance imaging (MRI). It is crucial that the examiner be aware of the strengths and limits of the method(s) used and those available for use.

Fig. 1. Bilateral pyeloureteric junction obstruction in a 6-week-old boy. a Plain radiograph of abdomen shows large mass on the left displacing descending colon. Mass was clinically impressive. b Film three hours post-intravenous contrast injection shows excessive dilatation of left renal pelvis and calyces with relative high contrast intensity; moderate right hy-dronephrosis. Scintigraphic estimation of renal function was 69% on the left, 31% on the right. Bilateral hydro -nephrosis had been discovered by fetal ultrasonography

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