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Figure it out fridays 



A two-year-old male, known case of speech delay, presented with a one day history of hematuria associated with foul smelling urine. No other symptoms were reported. The patient is a product of an uneventful term pregnancy, with no significant past medical history of note.

On examination, the child was afebrile and appeared clinically well. The abdomen was soft, lax, non-tender, and a small mass was felt in the lower abdomen. 

Genital examination revealed an undescended right testis. 

The cardiovascular, respiratory, and neurological systems were unremarkable


WBC 11.14x10^9/L         Hemoglobin of 11.6 g/dL           Platelet count 383 x 10^9/L        

Neutrophils 47.9%          Lymphocytes 39.20% 

Urea, Creatinine, Electrolytes, and Liver function tests were within normal limits

Microscopic urine analysis showed: blood hemoglobin positive, red blood cells more than 100, white blood cells 50-99. Leukocyte esterase +2. Nitrite positive. Urine culture Escherichia coli)

USS and MRI of the pelvis done

The decision was made to take the patient to the OT. Following are the intra-operative pictures. 

From the imaging and intra-operative pictures, what is your diagnosis?

A. Rhabdomyosarcoma

B. Inflammatory myofibroblastic tumor

C. Infected urachal cyst 

D. Fungal ball


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