What is the differential diagnosis?
In a 2 year old child the most common abdominal masses are neuroblastoma and Wilms tumours. Splenomegaly can also be considered as it arises on the left.
What features favour a Wilms tumour over neuroblastoma?
No calcification - over 90% of neuroblastomas have calcification. Otherwise there are no real features to suggest one of the over on this radiograph.
Large mass mainly on the left but crossing the midline, which displaces the bowel loops around it. No calcification seen. No bony abnormality.