A child presents with a right-sided abdominal mass and fatigue. The most likely diagnosis?

A child presents with a right-sided abdominal mass and fatigue. The most likely diagnosis?

• A. Hepatoblastoma
• B. Neuroblastoma
• C. Wilms' tumor
• D. Appendicitis

Answer: (C)

A unilateral, painless, firm abdominal mass in a young child is most suggestive of a Wilms tumor, a nephroblastoma arising from the kidney. This tumor commonly appears in preschool-aged children (roughly 2–4 years old) and presents as a single enlarging mass on one side of the abdomen, which fits a right-sided finding. Fatigue can accompany the condition, potentially from anemia or the systemic effects of the tumor. Wilms tumors are usually confined to one kidney and do not typically cross the midline, helping distinguish them from other tumors. Hepatoblastoma would present as a mass in the liver, most often in infants. Neuroblastoma can occur in the adrenal region and may cross the midline or present with systemic features, but it tends to affect younger children and may show signs like bone pain orOpsoclonus–myoclonus. Appendicitis presents with right lower quadrant pain, fever, and GI symptoms rather than a large, isolated abdominal mass. So the right-sided, unilateral, painless abdominal mass in a young child most strongly points to Wilms tumor.

A unilateral, painless, firm abdominal mass in a young child is most suggestive of a Wilms tumor, a nephroblastoma arising from the kidney. This tumor commonly appears in preschool-aged children (roughly 2–4 years old) and presents as a single enlarging mass on one side of the abdomen, which fits a right-sided finding. Fatigue can accompany the condition, potentially from anemia or the systemic effects of the tumor. Wilms tumors are usually confined to one kidney and do not typically cross the midline, helping distinguish them from other tumors.

Hepatoblastoma would present as a mass in the liver, most often in infants. Neuroblastoma can occur in the adrenal region and may cross the midline or present with systemic features, but it tends to affect younger children and may show signs like bone pain orOpsoclonus–myoclonus. Appendicitis presents with right lower quadrant pain, fever, and GI symptoms rather than a large, isolated abdominal mass.

So the right-sided, unilateral, painless abdominal mass in a young child most strongly points to Wilms tumor.