Ultrasound Case 050

Presentation

I was sent a small ultrasound machine to test. I asked my 8 year old son if I could scan his aorta. This is the scan which sent a ripple through our lives.


View 2


Describe and interpret these scans

IMAGE INTERPRETATION

Image 1: Transverse scan abdominal aorta superior to inferior. A homogeneous mass is seen lying in the left retroperitoneum adjacent to the aorta and inferior to the left renal vein.

LITFL Top 100 Ultrasound 050 03 retroperitoneal mass trans
Key to image 1

Image 2: Longitudinal view through the left kidney. The mass is seen sitting at the left renal hilum. My heart paused, I got a lump in my throat. What to do – ignore or investigate?

Key to image 2

The story continues

Further evaluation of the incidentaloma

Image 3 and 4
LITFL Top 100 Ultrasound 050 05 retroperitoneal mass Measured
LITFL Top 100 Ultrasound 050 06 retroperitoneal mass Doppler

Image 3: Image measuring the mass in longitudinal and transverse sections.

Image 4: Colour Doppler interrogation of the mass.

Image 5
LITFL Top 100 Ultrasound 050 07 retroperitoneal mass Nuclear medicine scan

Image 5: Nuclear medicine scan reported as showing a mass consistent with a neural crest tumour. Neuroblastoma is the most common of these.

Image 6
LITFL Top 100 Ultrasound 050 08 retroperitoneal mass Laparoscopic view

Image 8: Laparoscopic resection of the mass.


CLINICAL CORRELATION

Schwannoma

Histology showed this was a benign schwannoma. Ben has recovered well and we so appreciate the professionalism and kindness shown by those who cared for him and supported us through the adventure.

Look out for the incidentaloma.

They are common, make for difficult conversations and challenging decision making, and can permanently impact patients lives and those of their families.

Further reading

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TOP 100 ULTRASOUND CASES


An Emergency physician based in Perth, Western Australia. Professionally my passion lies in integrating advanced diagnostic and procedural ultrasound into clinical assessment and management of the undifferentiated patient. Sharing hard fought knowledge with innovative educational techniques to ensure knowledge translation and dissemination is my goal. Family, wild coastlines, native forests, and tinkering in the shed fills the rest of my contented time. | SonoCPDUltrasound library | Top 100 | @thesonocave |

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