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Newborn With Abdominal Mass and Distention

Newborn With Abdominal Mass and Distention

HISTORY

Baby girl born at 37 weeks' gestation to a gravida 2 para 1, 25-year-old mother by spontaneous vaginal delivery. Apgar scores, 8 at both 1 and 5 minutes. Placenta grossly normal with a 3-vessel cord. Prenatal course uncomplicated. Mother's blood type, A-positive. Results of prenatal testing negative for hepatitis, syphilis, rubella, group B streptococcal disease, and HIV infection. No significant maternal or family history.

PHYSICAL EXAMINATION

Vital signs normal. Birth weight, 3281 g (7.2 lb; 70th percentile); length, 50.5 cm (80th percentile); head circumference, 31 cm (10th percentile). Infant had significant abdominal distention secondary to a palpable smooth mass extending from the right upper quadrant to the right pelvis; liver edge difficult to determine. Mild cutaneous venous congestion over the abdominal wall; no other lesions or rashes. Abdomen firm; no guarding or dullness to percussion. Bowel sounds normal. No splenomegaly or other palpable abdominal masses.

Oropharynx and tongue normal. Lungs clear to auscultation. Heart rate and rhythm regular, with no murmur. Extremities and external female genitalia normal.

LABORATORY FINDINGS

Hemoglobin, 8.6 g/dL; hematocrit, 26.1%; white blood cell count, 31,200/μL; and platelet count, 99,000/μL. Aspartate aminotransferase, 229 U/L; alanine aminotransferase, 39 U/L. Total bilirubin, 5.1 mg/dL, with a direct component of 1.8 mg/dL at 20 hours of life. Prothrombin time of 17.7 seconds, partial thromboplastin time, 36.6 seconds; and international normalized ratio, 1.5.

IMAGING

Plain chest radiograph and abdominal CT scan shown.

"WHAT'S YOUR DIAGNOSIS?"

Answer on Next Page

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