Manipal Journal of Medical Sciences


A healthy two-year-old female child presented to the Emergency Department (ED) with lethargy and recurrent episodes of non-bilious and non-projectile emesis after sustaining a fall. On examination, she was found to be drowsy, but could be easily aroused with Glasgow Coma Scale (GCS) of 15. Her abdominal examination revealed a left quadrant mass. Initial laboratory test showed low haemoglobin. In the setting of trauma, the low haemoglobin and abdominal mass, there was a concern for splenic injury and haemorrhage. A CT scan of the abdomen and pelvis revealed a large mass arising from the left kidney suggestive of Wilms tumour. Wilms tumour is the most common primary renal malignancy in children and constitutes about 5% of all paediatric cancers. It is typically described as an asymptomatic abdominal mass noted by a caregiver and it may have vague and atypical presentations. Paediatric ER physicians are often the first point of medical contact for children with malignancy and play an important role in early diagnosis of paediatric cancers