Wilms' tumor; CT scan; hepatomegaly; intra-atrial
Yousif H. Matloub, MD (Pediatric Oncologist) he received dactinomycin (45 mcg/kg) and vincristine (1.5 mg/kg). The patient is a 5-year-old boy who presented with A follow-up echocardiogram performed 3 days after vomiting, abdominal pain, and distention. On physical starting chemotherapy showed the mass to have roughly examination, the patient was in moderate respiratory disdoubled in size. It was now seen to be occupying most tress and was found to have bilaterally decreased breath of the right atrial cavity and crossing the tricuspid annulus sounds, abdominal distention, a leftsided abdominal mass, (Fig. 3). Radiation therapy was then initiated with the and hepatomegaly.
hope that in combination with chemotherapy, it would halt the tumor's rapid growth. A total of 1,000 cGy was Tim Brown, MD (Pediatric Radiologist), R. Morrison given to the mediastinum with lung shields and paraaortic Hurley, MD (Pediatric Nephrologist) region down to the sacroiliac area, with shielding to the right kidney (Fig. 4). Radiation therapy was delivered in An abdominal CT scan revealed a leftsided abdominal 10 fractions with a 4 mv photon unit. mass arising from the left kidney and extending into the Five days after starting chemotherapy, the patient deleft renal vein and inferior vena cava (Fig. 1). It also veloped seizures and a transient encephalopathy. These showed hepatic venous congestion with hepatomegaly were thought to have been caused by vincristine in a and ascites. The chest CT showed right atrial extension background of worsening liver functions, as the patient's of the mass with large bilateral pleural effusions. No hepatic transaminases and serum bilirubin were found parenchymal metastases were seen. A percutaneous neeto have coincidentally increased from their pretreatment dle biopsy of the left kidney was attempted with no sucvalues. The seizures were readily controlled with phenytcess in obtaining tumor tissue.
oin, and the encephalopathy resolved in the following few days.