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Epilogue: Anaemia + abdominal mass = is it cancer?
  1. Peter McAlister1,
  2. Shana Irvine1,
  3. Rachel Beckett1,
  4. Emma O'Hagan2,
  5. David Marshall3
  1. 1 Paediatrics, Antrim Area Hospital, Antrim, UK
  2. 2 Paediatric Nephrology, Royal Belfast Hospital for Sick Children, Belfast, UK
  3. 3 Paediatric Surgery, Royal Belfast Hospital for Sick Children, Belfast, UK
  1. Correspondence to Dr Peter McAlister, Paediatrics, Antrim Area Hospital, Antrim, UK; peter.mcalister{at}

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A 2-year-old boy presented with several weeks of pallor, lethargy, intermittent fever and increasing abdominal distension. His temperature was 38°C and blood pressure was 122/62 mm Hg. On examination, there was a left upper quadrant abdominal mass, measuring 10 cm with palpable upper margins. Laboratory investigations are shown in table 1. Previously the boy had Proteus urinary tract infection (UTI) treated with oral antibiotics in the community but no further investigations. He was subsequently treated with intravenous antibiotics with no significant improvement.

View this table:
Table 1

Summary of investigations from admission


Question 1

What is the most appropriate first line imaging?

  1. Contrast-enhanced CT abdomen

  2. Ultrasound abdomen and pelvis

  3. Non–contrast-enhanced CT abdomen

  4. MRI abdomen

Question 2

Based on the imaging appearances in figure 1, what is the most likely diagnosis?

Figure 1

T2 diffusion-weighted MRI abdomen.

  1. Wilms’ tumour

  2. Nephrocalcinosis

  3. Renal cell carcinoma

  4. Xanthogranulomatous pyelonephritis

Question 3

What does the DMSA (dimercaptosuccinic acid) scan show? …

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  • Contributors PM and SI share responsibility for development of manuscript and article content. DM, RB and EO are responsible for editing and adding educational content.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.