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Neuroblastoma Masquerading as Constipation: Reducing Diagnostic Error With the Pediatric Abdominal Point-of-Care
Jonathan Schonert1, Nick Denne2, Joe Minardi2
1Department of Emergency Medicine, St. Luke's Hospital, Chesterfield, USA.
Insights
Point-of-care ultrasound (POCUS) aided in diagnosing a rare pediatric neuroblastoma presenting as abdominal pain. The pediatric abdominal POCUS survey (PAPS) exam can improve accuracy for vague abdominal pain in children.
Area of Science:
- Pediatric Emergency Medicine
- Diagnostic Imaging
- Pediatric Oncology
Background:
- Abdominal pain is a frequent pediatric emergency department complaint with varied etiologies, ranging from benign to life-threatening.
- Early and accurate diagnosis is crucial for conditions like neuroblastoma, which often present with non-specific symptoms.
- Point-of-care ultrasound (POCUS) offers a rapid, radiation-free, and cost-effective imaging solution.
Observation:
- A three-year-old male presented with persistent abdominal pain, constipation, poor appetite, and weight loss over three weeks.
- Initial evaluations presumed constipation, but POCUS revealed an aortic encasing echogenic mass with resultant hydronephrosis.
- Subsequent CT and biopsy confirmed the diagnosis of neuroblastoma.
Findings:
- POCUS successfully identified a significant abdominal mass in a pediatric patient with non-specific symptoms.
- The identified mass was diagnosed as neuroblastoma, a common childhood cancer.
- The case underscores the diagnostic utility of POCUS in challenging pediatric abdominal pain presentations.
Implications:
- POCUS can significantly aid in the early detection of serious intra-abdominal pathologies in children.
- The proposed pediatric abdominal POCUS survey (PAPS) exam may enhance diagnostic accuracy for vague pediatric abdominal pain.
- Integrating POCUS into the initial assessment can expedite diagnosis and treatment initiation for critical conditions like neuroblastoma.
Abstract:
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.
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