A 3-year-old child presents with a firm, non-tender abdominal mass discovered by a parent during bathing. The child is hypertensive but otherwise asymptomatic. Which initial diagnostic step is prioritized to maximize patient safety?

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TheoryPractice · Accepted Answer

Abdominal ultrasound. The correct answer is abdominal ultrasound. This presentation is highly suspicious for Wilms tumor (nephroblastoma). Ultrasound is the safest first-line imaging modality to confirm the mass without radiation or invasion. Distractor 1 is incorrect because vigorous palpation can rupture the tumor and upstage the disease. Distractor 2 is incorrect because biopsy is generally contraindicated due to spill risk before surgical excision. Distractor 3 is inappropriate as it delays diagnosis of a potential malignancy. Distractor 4 is insufficient given the palpable mass and hypertension.

A 3-year-old child presents with a firm, non-tender abdominal mass discovered by a parent during bathing. The child is hypertensive but otherwise asymptomatic. Which initial diagnostic step is prioritized to maximize patient safety?

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