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Abdominal Mass

Abdominal Lump

An abdominal mass can be observed during a physical examination in a myriad of conditions, but it is imperative to determine its location, size, shape and the presence of other accompanying signs. A thorough workup, primarily through imaging studies and biopsy, is pivotal to define the underlying cause.


Presentation

An abdominal mass is a constitutive feature of numerous autoimmune, infectious, malignant and congenital disorders, which is why its characteristics can narrow the differential diagnosis. Upon inspection, localization should be defined first, as masses in the right-upper quadrant are indicative of hepatobiliary tract disorders, such as cholecystitis and tumors of the liver and gallbladder, while pancreatic abscesses and pseudocysts, but also malignancies of the pancreas and stomach can present as a mass in the epigastric area [1]. On the other hand, lesions of the female reproductive tract (ovarian cysts, uterine myomas), diverticulitis are associated with a mass in the lower quadrants of the abdomen [1] [2]. Finally, masses in the flank area are highly indicative of kidney-related pathology. In fact, more than half of all abdominal masses in the pediatric population stem from kidney diseases, including malignancies (Wilms' tumor, neuroblastoma), polycystic kidney disease (PKD), hydronephrosis and the presence of an ectopic kidney [3]. One of the most important conditions that can be recognized with a simple palpation of an abdominal mass is an aneurysm of the abdominal aorta (AAA), in which a pulsatile mass in the umbilical area is a highly specific finding [4]. Apart from its location, it is important to note its consistency, fluctuation, and presence of accompanying symptoms. Fever, hematuria, weight loss, fatigue, abdominal pain, diarrhea, constipation, jaundice, dysmenorrhea, overlying skin lesions and hypotension can all be encountered, depending on the underlying cause [1] [5].

Epigastric Mass
  • A movable, firm and smooth epigastric mass 10 x 12 cm in size was found upon examination. Eventually the trichobezoar mass was surgically removed after a failed endoscopic removal.[ncbi.nlm.nih.gov]
  • Causes Upper abdominal/ epigastric mass retroperitoneal lymphadenopathy (e.g. lymphoma, teratoma) Abdominal aoertic aneurysm (AAA) gastric CA pancreatic pseudocyst or tumour pyloric stenosis transverse colon CA large recti left lobe of liver Right hypochondrium[lifeinthefastlane.com]
Rectal Mass
  • See also abdominal distension, kidney mass, splenomegaly, hepatomegaly, hepatosplenomegaly, rectal mass and scrotal mass.[lifeinthefastlane.com]
Scrotal Mass
  • See also abdominal distension, kidney mass, splenomegaly, hepatomegaly, hepatosplenomegaly, rectal mass and scrotal mass.[lifeinthefastlane.com]
Neglect
  • Trichobezoar is a differential diagnosis that is often neglected. Different from previously reported cases, we present a 3-year-old girl with sickle cell disease with complaints of acute abdominal pain, suspecting sickle cell splenic sequestration.[ncbi.nlm.nih.gov]
  • Diagnostic dilemma in a neglected case of fetus-in-fetu solved with Magnetic Resonance Imaging and MDCT. A case report and review of literature.[analesdepediatria.org]

Workup

A detailed patient history and a thorough physical examination can reveal key information about the underlying cause, and they must be pointed out as essential parts of the diagnostic workup. As mentioned previously, the location, size, consistency, mobility, as well as characteristics of edges and the surface can help in assuming the organs or tissues from which the mass originates, while basic patient information (age, gender) and a meticulously obtained history of present illness can further support the presumed diagnosis. If additional symptoms are presents, such as fever, hematuria, jaundice, etc, laboratory studies comprised of a complete blood count (CBC), urinalysis, liver and kidney function tests, as well as inflammatory markers test (C-reactive protein, erythrocyte sedimentation rate and fibrinogen) are necessary [1] [5]. Imaging studies, however, are the cornerstone of evaluating an abdominal mass and several procedures may be implemented. Ultrasonography can be performed as an initial procedure to examine the kidneys, liver, spleen, and the reproductive organs, while computed tomography (CT) and magnetic resonance imaging (MRI) are recommended if the cause remains unknown, especially if gastrointestinal (eg. gallbladder or intestinal perforation) or vascular (AAA) pathology is suspected [1] [4] [6]. In some cases, excision of the mass or biopsy can be indicated to confirm the etiology.

Actinomyces Israelii
  • The histological analysis of the specimen was inconsistent with a desmoid tumour and revealed an infection of Actinomyces israelii in the anterior abdominal wall that was confirmed with a microbiology culture.[ncbi.nlm.nih.gov]

Treatment

  • The surgical treatment was followed by a course of penicillin antibiotic therapy for 6 months. This treatment resulted in full recovery with no further complications.[ncbi.nlm.nih.gov]
  • Treatment Principle Herb Formulas Points Clinical Manifestations Itching or tickling in the throat Cough with expectoration of thin, watery or frothy white sputum Chills with low grade fever Anhidrosis No thirst Headache Aversion to Wind Blocked and [americandragon.com]

Prognosis

  • Favorable factors for prognosis are decreasing alpha-fetoprotein levels and complete resections. Overall disease free survival is 70% except for those patients presenting with initial metastatic disease.[pediatriceducation.org]
  • In utero percutaneous decompression of the larger cysts improves prognosis. 6 This tumor is often very large at initial detection, making surgical excision complicated.[jaocr.org]
  • Computed tomography is better than Ultrasonography in defining the extent and spread of teratoma to the surrounding organs. 7 The prognosis is excellent for benign retroperitoneal teratoma if complete resection can be accomplished.[bjmp.org]
  • These are much easier to treat and lead to a better prognosis than if you have sarcomatoid mesothelioma , which is unfortunately much more resistant and will lead to a poorer prognosis.[mesotheliomatreatmentcenters.org]
  • Clinicopathological features, prognosis, and relationship to other mucinous cystic tumors. Am J Surg Pathol 1999; 23:410–42 2. Le Borgne J, de Calan L, Partensky C.[giornalechirurgia.it]

Etiology

  • Age of the patient, location of the mass, and clinical presentation are key when considering etiologies.[consultant360.com]
  • In some cases, excision of the mass or biopsy can be indicated to confirm the etiology.[symptoma.com]
  • The most common etiology of an abdominal mass in a newborn is a benign urologic condition. These conditions include posterior urethral valves, ureteropelvic junction obstruction, or polycystic kidneys.[pediatricsurgeryorlando.com]
  • Have an idea of the anatomical structures in each section (figure 1) and relate that to possible etiologies of the abdominal mass.[learn.pediatrics.ubc.ca]
  • The most common etiologies of an abdominal mass in an infant include renal, GI, and pelvic masses, followed by adrenal and hepatic lesions.[jaocr.org]

Prevention

  • Suprapubic and pelvis Bladder : for example, a distended bladder caused by a blockage preventing you from emptying your bladder - such as in prostate gland enlargement in men. Womb (uterus) : for example, pregnancy, fibroids.[patient.info]
  • Unfortunately, modern low-dose oral contraceptive pills appear to have minimal efficacy in preventing progression of already enlarged physiological cysts. 4 If a cystectomy is performed, the cyst wall should be sent for pathologic examination.[consultant360.com]
  • […] suggests ascites) You may also want to percuss down until dull again (whilst the patient is on their side) and repeat the process on the other side Assess fluid wave/thrill ask the patient to place the medial side of their hand down the midline (this will prevent[dundeemedstudentnotes.wordpress.com]
  • Blockage generally results from stagnation of liver-Qi or improper diet preventing Qi from its normal dispersal. Blockage is generally located in the Qi Level, so that the principal factor is strong pathogenic evil.[what-when-how.com]

References

Article

  1. Porter RS, Kaplan JL. Merck Manual of Diagnosis and Therapy. 19th Edition. Merck Sharp & Dohme Corp. Whitehouse Station, N.J; 2011.
  2. Upchurch GR Jr, Schaub TA. Abdominal aortic aneurysm. Am Fam Physician. 2006;73(7):1198-1204.
  3. Gow KW, Koyle MA. Approach to Abdominal Masses. In: Guide to Pediatric Urology and Surgery in Clinical Practice. Springer. 2010;205-217.
  4. Keisler B, Carter C. Abdominal aortic aneurysm. Am Fam Physician. 2015;91(8):538-543.
  5. Rahhal RM, Eddine AC, Bishop WP. A Child with an Abdominal Mass. Hospital physician - Pediatric Rounds. 2006;37– 42.
  6. Indar AA, Beckingham IJ. Acute cholecystitis. BMJ. 2002;325(7365):639-643.

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Last updated: 2019-06-28 12:34