Content area
Full Text
Apreviously healthy three-year-old boy presented to the paedi- atric emergency department with a two-day history of left lower extremity swelling, tenderness and refusal to walk. There was no history of fever, recent travel, immobilization or trauma to the extremity. In the month leading up to his presentation, the patient was also noted by his mother to have decreased appetite and was requiring increasingly larger diaper sizes. His review of systems was otherwise unremarkable.
On examination, he was afebrile, with a normal heart rate and elevated blood pressure (115/68 mmHg). He was alert and in no acute distress. Examination of the left lower extremity revealed warmth, swelling and erythema of the inguinal region, with increased thigh girth compared to the right. There was no pitting edema distally. Bloodwork revealed a decreased hemoglobin level (104 g/L) and normal white blood cell and platelet counts, electro- lyte levels, renal function and uric acid. Urinalysis was normal. The lactate dehydrogenase level was elevated (1028 U/L; normal range 150 U/L to 360 U/L).
Ultrasound examination led to the diagnosis.
CASE 1 DIAGNOSIS: WIlmS tumOur WIth OCCluSIvE tumOur thrOmbuS IN thE COmmON fEmOrAl AND ExtErNAl IlIAC vEINS
Ultrasonography revealed a well-circumscribed mass replacing the right kidney consistent with Wilms tumour, with inferior vena cava, common femoral and left external iliac vein extension. A computed tomography (CT) scan provided further definition (Figure 1).
Our patient presented with localized lower extremity swelling, an...