A 5-MONTH-OLD male infant was admitted to the hospital with a 3-day history of fever associated with anorexia, fussiness, and decreased sleep. Information from a review of systems and history of present illness revealed a several-week history of constipation and gastroesophageal reflux. On physical examination the infant appeared healthy and had a nontender, firm, abdominal mass palpated in the right upper quadrant. The mass extended 9 cm below the costal margin. By auscultation, bowel sounds were present, and a diffuse low-pitched bruit was heard over the mass. Findings from the remainder of the physical examination were unremarkable.
Results of serum chemistry, liver function tests, prothrombin time, and partial thromboplastin time were normal. The complete blood cell count was remarkable for a hemoglobin level of 91 g/L and a platelet count of 203 × 109/L. Urine catecholamine levels were normal. His α1-fetoprotein level was greater than 60 µg/L (reference range, 0-15 µg/L). An abdominal radiograph showed an upper abdominal mass crossing the midline not seen on radiography performed 2 months earlier during evaluation of the patient's gastroesophageal reflux. An abdominal ultrasonogram (Figure 1) and a computed tomographic scan (Figure 2, Figure 3, and Figure 4) of the abdomen were performed.
Dabrow S, Neal M, Spoto-Cannons A. Radiological Case of the Month. Arch Pediatr Adolesc Med. 2000;154(3):307. doi:10.1001/archpedi.154.3.307