Presentation
Abdominal enlargement.
Patient Data
Marked hepatomegaly. There is a sizable well-defined right hepatic lobe hypodense mass with a heterogeneous texture. It is predominantly solid with cystic necrotic areas within and no calcifications. It pushes the right kidney downwards, displacing the pancreas to left side of the abdomen. The mass is markedly compressing the inferior vena cava proximal to the heart. Prominent azygos venous system. Retro-aortic left renal vein.
Moderate free ascites, extending to right inguinal region.
Multiple pulmonary nodules are noted, impressive of pulmonary metastases.
Case Discussion
The age and CT features are in favor of a large hepatoblastoma with pulmonary metastases. It is considered the most common primary hepatic neoplasm in children under four years. They usually present with a painless abdominal mass. Calcifications are only present in 40% of cases.
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