# Missed diagnosis of giant hydronephrosis mimicking abdominal lymphatic malformation or omental cyst in a 16-year-old girl: A case report

## TL;DR

A 16-year-old girl was misdiagnosed with a lymphatic malformation or omental cyst, but surgery revealed she had rare giant hydronephrosis.

## Contribution

Highlights the diagnostic challenge of giant hydronephrosis in adolescents and its potential misdiagnosis as abdominal cystic masses.

## Key findings

- A 33-cm cystic mass was surgically removed and diagnosed as giant hydronephrosis.
- Histopathology confirmed atrophied renal tissue and a dilated renal pelvis.
- The patient recovered well post-surgery and was discharged in good condition.

## Abstract

Giant hydronephrosis (GH) is an uncommon urological disease most often identified and managed during infancy or childhood. Diagnosing GH prior to surgical intervention can be difficult, resulting in potential misdiagnoses as ovarian tumors or intraabdominal cystic masses. Management of GH depends on the underlying pathology and the renal function of the affected kidney.

A 16-year-old girl presented to local clinics with a 1-month history of abdominal distention and irregular menstruation. Abdominal computed tomography revealed a 33-cm cystic mass occupying the entire abdomen and displacing the bowel posteriorly, suggesting a lymphatic malformation or an omental cyst. The patient underwent emergent exploratory laparotomy. A 33-cm cystic mass originating from the right retroperitoneum was discovered and removed without complications. Histopathologic examination showed atrophied renal parenchyma and a dilated renal pelvis, confirming GH. The patient's postoperative course was uneventful, and she was discharged on postoperative day 7 in good condition.

GH is a rare urological condition that is difficult to diagnose preoperatively, often leading to potential misdiagnoses.

Although GH is exceedingly rare in the pediatric population, we recommend including it in the differential diagnosis of large intraabdominal cystic masses in pediatric patients.

•Diagnosing giant hydronephrosis (GH) prior to surgical intervention can be difficult, resulting in potential misdiagnoses as ovarian tumors or intraabdominal cystic masses.•Management of GH depends on the underlying pathology and the renal function of the affected kidney.•Although GH is exceedingly rare, it should be included in the differential diagnosis of large intraabdominal cystic masses in pediatric patients.

Diagnosing giant hydronephrosis (GH) prior to surgical intervention can be difficult, resulting in potential misdiagnoses as ovarian tumors or intraabdominal cystic masses.

Management of GH depends on the underlying pathology and the renal function of the affected kidney.

Although GH is exceedingly rare, it should be included in the differential diagnosis of large intraabdominal cystic masses in pediatric patients.