Background and aim: Abdominal distention and pain are common symptoms in children presenting to the emergency medicine department. Several publications have described the application of POCUS to advance the work up of abdominal complaints and facilitate the diagnosis of abdominal tumors in the pediatric population. We aim to demonstrate the clinical efficacy in assessing abdominal complaints by POCUS in the pediatric emergency department. 

Methods: Clinical case presentation

Results:  A 7 months old infant presented to the PED due to restlessness, crampy abdominal pain and abdominal distention for one week along with 2 days of fever and dyspnea. Physical examination demonstrated a mildly tender, distended abdomen with suprapubic dullness to percussion and diminished bowel sounds.
POCUS was performed using a linear transducer (Phillips CX50, L8-12 MHz) and a large heterogenic solid tissue mass was noted with internal blood flow when using color mode (Fig 1). 
The patient was admitted for work up that revealed an extremely high level of α-Feto-protein and a large heterogenic abdominal mass on MRI (Fig 2). Open biopsy confirmed the diagnosis of Yolk sac tumor. The infant received chemotherapy with favorable outcome and is currently doing well. 

Conclusion: This case demonstrates how real time POCUS was crucial in narrowing down the differential diagnosis of the infant. As PED physicians become more experienced in POCUS we believe that the role of bed-side POCUS in improving efficient work up, specialty care and further imaging will increase.

DIAGNOSIS OF YOLK SAC TUMOR FACILITATED BY POINT OF CARE ULTRASOUND (POCUS) IN THE PEDIATRIC EMERGENCY DEPARTMENT