Abdominal, groin or testicular swelling

Question 1

Commonest malignancies in children

Answer 1

Leukaemia,
Brain tumours
Lymphoma

Question 2

Malignancies that cause abdomen masses

Answer 2

Neuroblastoma

Wilm’s tumour

Question 3

Common causes of abdominal and scrotal masses in paeds.

Answer 3

Faecal masses
Neuroblastoma
Nephroblastoma(wilm’s tumour)
Lymphoma

Question 4

DDX for painful scrotal mass

Answer 4

Emergency- surgical
Testicular torsion
Incarcerated hernias

Question 5

DDX for Swelling of goin

Answer 5

Inguinal hernia
Testicular torsion
Inguinal lymphadenopathy
Hydrocele
Infection

Question 6

DDX for impalpable testes

Answer 6

Retractile testes
Undescended testis
Ectopic testes

Question 7

Inguinal hernia

Answer 7

Common in preterm infants
Increase in size when baby cries
Swelling extends up into the groin and does not transilluminate
Testes are palpable and distinct from the swelling
Reduction of the swelling is diagnostic
No pain unless incarcerated
Mx - Surgery

Question 8

Testicular torsion

Answer 8

Surgical emergency
Tender swollen scrotum
Intense pain
Occurs in puberty boys

Question 9

Inguinal lymphadenopathy

Answer 9

Firm nodules with clear borders
May be tender
Responsible infected lesion may be found in leg

Question 10

Hydrocele

Answer 10

Often present from birth and usually resolves by 12 months
No pain
Does not extend into the groin
Testis cannot be palpated through the fluid
Transilluminates
Mx - self resolves

Question 11

Retractile testis

Answer 11

Brought down by careful palpating

Ex the child with warm hands, and cross-legged or squated

Question 12

Undescended testis

Answer 12

May be unilateral or bilateral
More common in premature babies
May be associated with inguinal Bernie
Mx - Orchidopexy required by 1 yr to avoid infertility, torsion and malignancy

Question 13

Ectopic testes

Answer 13

Testes descend but along an abnormal path

May be in superficial inguinal pouch or on perineum.

Question 14

Bilateral impalpable testes

Answer 14

Rarely be a manifestation of a virilized female eg CAH
Pelvic USS is needed
Can be a sign of severe anterior pituitary dysfunction especially if associated with micro penis.

Question 15

Wilm’s tumour - Nephroblastoma

Answer 15

Presents as abdominal mass
Mean age is 39 m
Predisposing syndromes frequently present
Metastasis in 10% to lung and liver
Prognostic factors depend on stage and histology

Question 16

Neuroblastoma

Answer 16

Symptoms - pain and anaemia
Mean age 22 m
Predisposing syndromes - Rare
Metastasis 70% to skin and liver in infants and bone marrow and bone in older children.
Prognostic factor - age, biology, histology and stage.