The evaluation of abdominal masses in children with emphasis on noninvasive methods. A roentgenographic approach

Abstract

Intravenous urography with total body opacification, and tomography as required, often give the most information toward evaluating abdominal masses in children. Ultrasonography is a noninvasive procedure which defines normal structures and differentiates cystic and solid tumors. The combination of these studies gives sufficient information about renal tumors to plan for possible surgery. Arteriography is not necessary for the diagnosis of Wilms' tumor, nor its surgical or medical management. Pseudotumor of the kidney is due to focal cortical hyperplasia. It can be diagnosed by nephrotomography, renal arteriography or renal scanning. The latter method is most accurate and has the lowest morbidity. Aortography is advisable in the evaluation of a patient with pheochromocytoma in an attempt to locate multiple tumors. Determining the extent of abdominal neuroblastoma by angiography and lymphangiography does not appear to influence the mode of therapy, not the survival rate; therefore, invasive diagnostic procedures do not appear to be indicated in neuroblastoma. Angiography is necessary in the evaluation of liver cancer. If one lobe is determined to be free of disease, lobectomy is a possible cure. Splenic cysts and choledochal cysts can be diagnosed by noninvasive methods such as ultrasonography or radioisotope scanning. Arteriography and percutaneous opacification are not necessary to make these diagnoses.