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Virtual Pediatric Hospital: Correlapaedia - a Correlative Encyclopedia of Pediatric Imaging, Surgery, and Pathology: Case 32

Correlapaedia - a Correlative Encyclopedia of Pediatric Imaging, Surgery, and Pathology

Case 32

Michael P. D'Alessandro, M.D.,
Steven J. Fishman, M.D.,
Deborah E. Schofield, M.D.

Peer Review Status: Internally Peer Reviewed
Chief Complaint:
Newborn 32 week premature female with a renal mass diagnosed on prenatal ultrasound.

Clinical History:
The patient was a female noted on prenatal ultrasound to have a large renal tumor that grew over time with the patient. The patient was delivered at 32 weeks by emergency Cesarean section due to fetal distress. After delivery she developed severe respiratory distress which could not be alleviated. This respiratory distress was felt to be partially due to the large abdominal mass.

Clinical Physical Exam:
Large palpable right sided abdominal mass.

Clinical Labs:

Clinical Differential Diagnosis:
Mesoblastic nephroma, neuroblastoma

Imaging Findings:
A babygram taken immediately after birth showed a large right sided abdominal mass. An ultrasound exam from the same day showed the large right sided mass to be renal in origin.

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Imaging Differential Diagnosis:
Most likely mesoblastic nephroma. Less likely neuroblastoma.

Operative Findings:
The patient was taken emergently to the operating room after the ultrasound. A very large right renal tumor was found that had displaced the entire contents of the abdomen to the left. The tumor was resected. During the surgery the inferior vena cava was damaged via a small incision and was repaired.

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Pathological Findings:
Examination of the surgical specimen revealed findings characteristic of mesoblastic nephroma.

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Final Diagnosis:
Mesoblastic Nephroma

Follow-up and Prognosis:
The patient developed a post operative hematoma after the nephrectomy, probably due to the intraoperative damage to the inferior vena cava. This resulted in severe hypotension for one week post operatively. She also had respiratory distress syndrome, cholestasis, retinopathy of prematurity, and a patent ductus arteriosus.

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