Approach to abdominal masses

Pediatricians commonly see abdominal masses in their patient population. While most abdominal masses will not require surgery, it is estimated that 40% will. The key task for the clinicians is to determine which need further work-up. Most disorders originate from the retroperitoneum with the kidney accounting for more than half of the lesions. Only 10% will arise from intraperitoneal organs. While most lesions in infants are benign in nature (Fig. 22.1), there is a higher risk of malignancy in older children (Fig. 22.2). The method of determining which abdominal masses need surgical attention involves a thorough history and physical, followed by selected laboratory tests, and focused diagnostic imaging (Fig. 22.3).