Selected images from an emergency ultrasound performed by the on call radiologist in a general hospital (without paediatric surgical services) reveals a large heterogenous mass occupying the majority of the right upper quadrant.
Within the soft tissue mass centrally there is echogenic layered material thought to be haemorrhage. The mass is difficult to locate to one organ due to its size however the mass is positioned above the right kidney wand unable to separate from the right kidney.
The differential diagnosis included renal tumour, large adrenal haemorrhage or mass and late presenting neuroblastoma.
An urgent CT with arterial phase was advised to assess for active haemorrhage and diagnosis due to the patient's condition, whilst a transfer to a specialist paediatric centre was arranged by the referring emergency department.