Left Upper Quadrant Masses in Children

The discovery of an abdominal mass in a child alarms and concerns both parents and the physician. The diagnosis and treatment of these lesions have undergone significant changes during the past few years, and the physician understandably may have some doubts about an appropriate diagnostic evaluation. An improved outcome can be expected with early detection and prompt treatment. As is the case in evaluating all abdominal problems, a careful physical examination is critical and may obviate the need for further investigations. An accurate history is also important, but this often is clouded by information from parents or other historians who may not have all the data at their disposal. The child may be too young, may not remember the exact chronology and occurrence of events, or may be afraid to relate them. This is particularly true if the incident involved trauma related to an act forbidden by the parents. It is critical that the child be calm and relaxed to make the examination effective, often a nearly impossible feat. This occasionally can be accomplished with a few words from the examiner and the assurance that no pain will result from simple palpation. Patience often is rewarded with a good examination; however, should this approach fail, the physician may resort to sedation.