Neuroblastoma Masquerading as Constipation: Reducing Diagnostic Error With the Pediatric Abdominal Point-of-Care...

Abdominal pain is a common pediatric complaint in the emergency department and other clinical settings. While most causes are benign, dangerous and time-sensitive conditions may be present. Point-of-care ultrasound (POCUS) is a diagnostic modality that can help more thoroughly explore the differential diagnosis at a relatively low cost, without exposure to ionizing radiation, and in a timely manner.  This report presents the case of a three-year-old male with three weeks of abdominal pain, constipation, poor appetite, and weight loss that were evaluated multiple times for presumed constipation. POCUS at a rural critical access emergency department revealed an echogenic mass encasing the aorta and causing hydronephrosis, later confirmed as neuroblastoma on CT and biopsy. Comprehensive oncologic care was initiated at a tertiary care center. Neuroblastoma, one of the more common forms of childhood cancer, particularly in the first year of life, often presents with non-specific symptoms that can delay diagnosis. This case report highlights the role of POCUS, and the authors introduce the incorporation of the PAPS exam (pediatric abdominal POCUS survey) in the evaluation of vague pediatric abdominal pain to improve diagnostic accuracy and reduce errors.