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Special Feature
May 2006

Picture of the Month—Quiz Case

Author Affiliations


Arch Pediatr Adolesc Med. 2006;160(5):499. doi:10.1001/archpedi.160.5.499

A 7-year-old girl presented with 6 days of vomiting and abdominal pain in addition to a 3.5-kg weight loss over the past 6 months. On examination, she was pale and thin. Her weight was 16.9 kg (<5th percentile for age), and her height was 116 cm (10th percentile). Abdominal examination revealed a well-defined, firm, mobile, nontender, and nonpulsatile 8 × 8-cm mass in the left upper quadrant extending into the epigastric region. Laboratory studies showed a microcytic anemia with a hemoglobin concentration of 9.0 g/dL; the hematocrit was 26.8%. Amylase and lipase levels were normal. Hemoccult test results for stool and emesis were positive for blood. Abdominal radiography was performed (see Figure 1 and Figure 2).

Figure 1. 
Upright radiograph of the abdomen.

Upright radiograph of the abdomen.

Figure 2. 
Kidneys, ureters, and bladder (KUB) radiograph.

Kidneys, ureters, and bladder (KUB) radiograph.

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