Paeds - GI/GU/Gynae Flashcards
How to approach renal masses in kids
What is most common in Neonates?
What is most common in pre-school 6-12 years?
Approach by age
Neonates
1. Mesoblastic nephroma is most common solid mass
- can have cystic areas due to necrosis
- WONT invade collecting system or renal vein (Wilms will)
2. Nephroblastomatisis
3. Multicystic dysplastic kidney
-whole kidney is replaced by cysts with fibrous septations therefore they do not communicate
Overall apperance said to resemble bunch of grapes
(Hydronephrosis can be mimic however apparent cysts will communicate)
No renal function on MAG3
Most common renal masses in pre school aged 4 ish?
What is claw sign?
1. Wilms
Solid tumour that invades. Mets to lung
Enhances but less so than normal parenchyma
Claw sign is where some normal renal tissue stretches around mass
- 10% bilateral*
- 10% vascular invasion*
- 10% calcification*
2. Lymphoma
3. Multilocular cystic nephroma
- Mass of cysts but importantly they will be surrounded by a thick fibrous capsule.
- Protrusion into the renal pelvis is also a key finding, but this is also seen in some Wilms tumours.
- There shouldn’t be a solid component to this mass but enhancement of the septae separating the cysts may be seen on cross-sectional imaging.
Neuroblastoma
Most common abdominal mass in infants
Locations:
- adrenals
- retroperitoneum
- posterior mediastinum
Presents with abdo pain, large mass and fevers
Most secrete catecholamies
-VIP (diarrhoea)
-VMA (leads to HTN)
- Can have speckled calcification*
- Encases IVC*
- Can displace or invade the IVC*
Name the main 2 AFP secreting ovarian tumours in teenagers?
1. Leydig sertoli tumour
Tumours secrete oestrogen or testosterone or both therefore amenorrhoea
- AFP elevated
- Solid fibrous tumours = Low MR signal
- Can have cystic elements
2. Yolk Sac tumour
Large mass with or without cystic areas
Does NOT produce oestrogen or progesterone
Gynae Summary
What age group in females do germ cell tumours occur in?
Children and young adults
Germ Cell tumours include:
- Teratomas
- Choriocarinomas
- Yolk sac tumours
- Ovarian embryonal carinoma
Dysgerminoma is the malignant once (accounts for 5% germ cell tumours)
- Thick septa is a sign of malignant tumour*
- Can tort
- Can cause elevation in HCG
- Menstrual irregularity common
What are granulosa cell tumours?
What age do they appear?
How to differentiate from mucinous cystadenoma?
Oestrogen secreting tumour (therefore can cause endometrial thickening and PMP bleeding)
Occur in women of ANY age (more common in adults though)
Large, multicystic with thick septations
Differentiate from mucinous cystademona as they dont contain intracystic papillary projections
Kids with recurrent UTI’s
What are investigations?
- US within 6 weeks
- DMSA 4 - 6 months to look for scaring
What is best radionuclide study for looking at Neuroblastoma?
MIBG with planar and SPECT imaging
What is screening frequency for patients at risk of Wilms (patients with Beckwith Wiedman)
3 monthly US kidneys
What is Prune belly triad?
- Undescended testes
- Abdominal wall muscle insifficiency
- Non obstructed distended ureters
Almost always in males
What is Beckwith Wiedmann syndrome?
(EMG Syndrome)
Congenital overgrowth syndrome (exomphalos, macroglossia, giagantism)
- -Macroglossia*
- -Omphalocele (same as Exomphalos)*
- -Hemihypertrophy (increased size in one side of body)*
- -Hepatosplenomegaly*
Increased risk of Wilms, Hepatoblastoma and Neuroblastoma
What is WAGR syndrome?
Wilms
Aniridia (partial or complete absence or iris - colour of eye)
GU abnormalities
Retardation
What condition predisposes to Chromophobe RCCs?
Burt Hogg dube
Neuroblastoma vs Wilms?
Regular and stippled calcification in Neuroblastoma
Less common in Wilms - which can have curvilinear calcs
Neuroblastomas secrete catecholamines - VMA and VIP
-they are assc with :
Opsomyoclonus: rapid jerky eye and leg movements
Hutchinsons: limping due to bony mets
What is Page kidney?
Hypertension as a result of external compression on kidneys from capsular haematoma or other things
Activated RAAS system
Can see distortion of the kidneys with delayed arterial washout
Congenital adrenal hyperplasia
Features of adrenals on US?
Diffuse enlargement and ‘cerebriform morphology’
HyPOechoic adrenal cortex
HypERechoic medulla
Males: Electrolyte disturbance
Females: ambiguous genitalia. ovaries can be hard to see on US
Paeds followup for UTIs
Is there followup US or MCUG for acute infection which resolves within 48 hours?
Testicular torsion
What are signs of missed torsion?
Heteogenous testis with increased PERI-testicular flow but absent testicular flow in a patient with symptoms longer than 24 hours
What is Bell clapper deformity?
High insertion of the tunica vaginalis onto the spermatic cord
Grading of reflux on MCUG?
What is grade IV?
Grade 4 is tortuous ureter with moderate dilatation of pelvicalyceal system
