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The finding of a palpable mass in the abdomen of a child requires immediate evaluation. Many of these masses are found by parents or on routine physical exam. The diagnostic consideration is broad and can be caused by organomegaly, congenital anomalies, tumors and infection. The patient’s age, sex, and location of the mass significantly influences the differential diagnosis. Determining the organ or tissue of origin and whether the mass is cystic or solid can significantly narrow the diagnostic possibilities.