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75-80% Benign genitourinary lesions Most common Congenital obstructive hydronephrosis Multicystic dysplastic kidney Bulky and smooth Flank

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GU masses Ureteral duplications and Ureteroceles May produce obstructive uropathies that lead to palpable masses PUV Bilateral flank masses Most common cause of distal urinary tract obstruction in boys

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Mulitcystic dysplastic kidney Unilateral, soft, cystic Renal vein thrombosis Hyperviscocity syndromes Severe neonatal dehydration Mesoblastic nephroma Benign renal tumor Mimics Wilms

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Ovarian cysts Maternal hormone stimulation Withdrawal leads to resolution >5cm at risk for torsion Should be aspirated Congenital vaginal obstruction GI duplication cysts Diagnosis often made later

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Mesenteric and omental cysts Soft, diffuse and multiloculated Due to congenital lymphatic obstruction May have acute hemorrhage Acute abdominal pain

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Adrenal masses Common Benign Spontaneous adrenal hemorrhage Perinatal stress Birth trauma Neuroblastoma Malignant

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Intra-abdominal extra lobar sequestration Adjacent to adrenal gland Suggests a malignancy Sacrococcygeal teratoma Most common malignancy of infancy

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Bulky RUQ mass Fixed Benign Hemangioendothelioma AVM Mesenchymal hamartoma Choledochal cysts

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Underlying hematologic disease Immunodeficiency Lymphoproliferation Splenic cysts Congenital Trauma

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A premenstral 12 yo F presents to clinic with a history of abdominal pain occuring once a month. The abnormal physical exam finding is pictured. What other abnormalities is this patient at risk for? A. GU B. Cardiac C. Brain D. GI E. Limb

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Mostly seen in adolescence >75% benign Cystic 25% Solid Malignant changes

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Puberty Cyclic abdominal pain Large pelvic or lower abdominal mass Absence of menses May have hydronephrosis Obstruction Coexisting GU abnormalities Newborns Hydrocolpos

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Characteristics Tender Systemic symptoms Persistent signs of sepsis Causes Bowel perforations Meckel diverticulitis Crohns VP shunts Omentum and adjacent bowel loops migrate to localize the process and an abscess cavity forms

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Treatment IV antibiotics Percutaneous drainage Crohns Fistula Failure to respond to medical therapy Upper GI with SBFT BE

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Most lesions are benign Critical PE findings Determination of size Evidence of airway compromise Signs of inflammation Presence of sinus tracts Ocular involvement

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Radiology CT or MRI Bony structures Vascular structures Brain involvement Endoscopic procedures Nasopharyngoscopy, laryngoscopy and esophagoscopy Disorders of breathing, swallowing or phonation

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Surgery Frequently necessary for diagnosis and therapy Unnecessary cases Hemangioma Torticollis Benign reactive adenopathy

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The parents of a 1 month old M infant are concerned about a red lesion that has appeared on his upper forehead. On exam, it appears to be a small 1cm hemangioma. What do you tell them? A. This child needs referral to a dermatologist for medical treatment B. The lesion is benign and will resolve during the first 7 years of life C. Surgical intervention is necessary because it is on the face D. The lesion is unlikely to resolve on its own E. This lesion has a high malignant potential

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Hemangiomas Benign, congenital vascular tumors Most frequent in head and neck Characteristics Raised Red or purple May blanch May not be present at birth Develop in the first few months of life

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Hemangiomas Kasabach-Merritt Syndrome Due to rapid growth and expansion Platelet sequestration Coagulopathy Refractory to treatment Typical course Benign Spontaneous resolution over first 7 years Surgical intervention Airway compromise Periorbital involvement

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Congenital lesions Composed of Hair Skin Sebaceous structures Occur in areas of embryonic fusion Most frequent in head and neck Also found in sacral, perineal and sternal region

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Characteristics Well-circumscribed Firm Fixed to deep structures Always evaluate by MRI before surgical intervention for extention Treatment is surgical

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Preauricular skin tags Vestigial cartilaginous remnants Cosmetic Preauricular pits or sinuses Prone to infectious complications Epidermal inclusion structures Most lesions asymptomatic Surgical resections for infectious complications

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Parotid Gland Hemangiomas Viral Mumps Bacterial Staphylococcal Mycobacterial Atypicals or TB Chronic inflammatory conditions

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Intraoral lesions Ankyloglossia inferior Tongue-tie Usually resolves spontaneously Regresses with feeding Speech problems if persistent Treatment Simple division

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Ranula Pseudocysts in the floor of the mouth May spontaneously resolve Few become large Impairs lingual mobility Impairs speech Impairs breathing Treatment Marsupialization or complete excision

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Lymphangiomas May cause obstruction if mouth involved Smaller, vesicular lesions located on the tongue may exude fluid that becomes purulent May need antibiotics Treatment Possible partial glossectomy Speech development, mandibular growth

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Lingual thyroid Rare developmental anomaly of the thyroid Failure of thyroid descent Located at the base of the tongue (foramen cecum) Presentation Acute airway obstruction Lump in the throat on swallowing Hypothyroidism Treatment Thyroid replacement Surgical excision if obstructive