Afghan male of 15 days of life (2.9 kg of weight and 47 cm of height) assessed in the Spanish Role 2E of Herat (Afgganistán) with a picture of normal size 3 bowel movements day accompanied by vomiting.
Examination revealed a distended abdomen and a mass occupying the left hypochondrium and the mesogastrium.
Telemedicinaa was consulted with the Pediatric and Pediatric Surgery Services of the Hospital Central de la Defensa "Gómez Ulla".
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A gastroduodenal study (GED) with gastrografin® and an abdominal ultrasound were performed at this center.
The EGD showed the passage of contrast to the duodenum and a zone of "radiological silence" in the left hemiabdomen, with displacement of small intestine loops.
The ultrasound showed a heterogeneous mass of approximately 5 cm.
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The initial diagnostic suspicion of the mass was that it was a neuroblastoma, without ruling out other possibilities.
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Radiological diagnosis: Hepatoblastoma
Among the most frequent tumors in the neonatal period are neuroblastoma, teratoma and Wilms tumor.
In this case, the initial clinical suspicion was oriented towards a neuroblastoma after physical examination and inical complementary tests.
This extracraneal solid tumor derived from neural crest cells is the most common in this age group and the adrenal medulla is its most typical location1.
A new consultation was made by Telemedicin to the Radiology Services of the Central Hospital of Defense and Hospital San Juan de Dios of Barcelona.
Abdominal CT was indicated because magnetic resonance imaging is not available in the operating room.
The radiological diagnosis was hepatoblastoma.
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Hepatic tumors in neonates usually present as asymptomatic masses.
Lesions are usually malignant or metastasized due to a neuroblastoma.
Congenital hepatoblastoma is the most common malignant liver tumor, usually has elevated alpha-fetoprotein and its treatment includes adjuvant chemotherapy with cytoreductive intention and subsequent surgery; liver transplantation may be indicated.
The presence of standard telemedicin equipment in the first health steps deployed in the different areas of operations helps the diagnosis and treatment of patients affected by non-frequent diseases in different areas medical specialists or who are difficult to diagnose.
