Abdominal mass

From Medical-Wiki

The appearance or discovery of an abdominal mass may or may not imply significant pathology.

Characterization of the mass

The mass should first be characterized according to which quadrant of the abdomen it is located. Inspection should then be used to characterize it as to whether or not it moves with respiration, whether or not it exhibits peristalsis.

The area of the mass should then be auscultated for bowel sounds, bruits or rubs. Palpation should then be performed for tenderness, firmness, a sense of it being air filled, and its edges and general contour.

Once these factors have been ascertained, an initial differential diagnosis may be formed.

Masses in the various quadrants

• Right upper quadrant masses include liver, right kidney, and gallbladder. Less commonly, because it is posterior, is a right sided colonic mass or gastroduodenal mass. The liver moves down with inspiration. Since it is an anterior organ, its edges should be easily palpable. If a right kidney is significantly enlarged, it may rarely be palpable. The gallbladder should also move with inspiration.

• A mass in the left upper quadrant suggests spleen, gastric mass, left kidney, and rarely a left colonic mass. The spleen moves downward with inspiration. It has an oblique longitudinal axis and extends toward the right lower quadrant when enlarged.

• A right lower quadrant suggests colon, distal small bowel, and appendix, or ovary, uterus, or fallopian tube. GI structures are often ill-defined. If they are associated with inflammatory bowel disease, the mass is usually tender. A carcinoma of the cecum, however, would not be tender.

• GYN structures should be checked with a bimanual examination.

• Left lower quadrant masses include masses of the sigmoid as well as pelvic structures. [1]

Differential diagnosis

The differential diagnosis that corresponds to these findings includes abdominal aortic aneurysm (all quadrants), bladder distension (llq, rlq), cholecystitis (ruq), Crohn’s disease (all quadrants), diverticulitis (llq), hydronephrosis (ruq, luq), renal carcinoma (ruq, luq), liver cancer (ruq), hepatomegaly (ruq), neuroblastoma, ovarian cyst (llq, rlq), ovarian cancer (llq, rlq), pancreatic abscess (ruq, luq), pancreatic pseudocyst (ruq, luq), splenomegaly (luq), stomach cancer (luq), uterine leiomyomata (llq, rlq), and volvulus (all quadrants). [2]