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].

urogenital
Urinary Retention
  • […] pigtail catheter Family history Physical Exam Supine : shape, umbilicus, hernias Mass: location, size, shape, texture, mobility, tenderness, solid, cystic, air filler If distension attempt to relieve to improve exam: NG for obstruction, Crede cath for urinary[pedclerk.bsd.uchicago.edu]
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  • gastrointestinal
    Constipation
    • A mass in the right abdomen, accompanied by diarrhea or constipation, emaciation and weakness, is located in the intestines.[americandragon.com]
    • Ask about constipation, oliguria .. that might indicate gastrointestinal or genitourinary obstruction. · Ask about the presence or absence of watery diarrhea .[prezi.com]
    • Key Conditions Foundational Knowledge Resources Appendicitis Constipation Functional abdominal pain Neuroblastoma Ovarian torsion Pregnancy Wilm’s tumor Describe the anatomy, physiology and embryology of the gastrointestinal, genitourinary and reproductive[pupdoc.ca]
    • She also denied any GI complaints, such as vomiting, constipation, bloating, or hematochezia.[pediatricsconsultantlive.com]
    • Therefore, in the first instance, you are more likely to be aware of a mass caused by a problem with your gut (bowel) because of other symptoms such as abdominal pain , diarrhoea , constipation , rectal bleeding or weight loss .[patient.info]
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  • neurologic
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  • Face, Head & Neck
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  • Liver, Gall & Pancreas
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  • 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.

    Laboratory

    Serum
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  • Imaging

    X-ray
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  • Treatment

    Prognosis

    Complications

    Constipation
    • A mass in the right abdomen, accompanied by diarrhea or constipation, emaciation and weakness, is located in the intestines.[americandragon.com]
    • Ask about constipation, oliguria .. that might indicate gastrointestinal or genitourinary obstruction. · Ask about the presence or absence of watery diarrhea .[prezi.com]
    • Key Conditions Foundational Knowledge Resources Appendicitis Constipation Functional abdominal pain Neuroblastoma Ovarian torsion Pregnancy Wilm’s tumor Describe the anatomy, physiology and embryology of the gastrointestinal, genitourinary and reproductive[pupdoc.ca]
    • She also denied any GI complaints, such as vomiting, constipation, bloating, or hematochezia.[pediatricsconsultantlive.com]
    • Therefore, in the first instance, you are more likely to be aware of a mass caused by a problem with your gut (bowel) because of other symptoms such as abdominal pain , diarrhoea , constipation , rectal bleeding or weight loss .[patient.info]
    Intestinal Obstruction
    • . - Auscultation: Listen for bowel sounds to assess for intestinal obstruction - Palpation: light palpation of 4 quadrants and flank area.[prezi.com]
    • obstruction and their clinical manifestations Identify investigations that may be used in the evaluation of abdominal pain Overview & Foundational Knowledge Ross A & LeLeiko NS.[pupdoc.ca]
    • obstruction ( K56.- ) newborn gastrointestinal hemorrhage ( P54.0- P54.3 ) newborn intestinal obstruction ( P76.- ) pylorospasm ( K31.3 ) signs and symptoms involving the urinary system ( R30-R39 ) symptoms referable to female genital organs ( N94.-[icd10data.com]
    • Absent bowel sounds or tinkling bowel sounds could be a feature of intestinal obstruction.[dundeemedstudentnotes.wordpress.com]
    • Abdominal pain, anorexia, vomiting, anemia, pancreatitis, hypoalbuminemia, and jaundice may be present. 8,9 Reported complications of trichobezoars include intestinal obstruction and perforation, gastric ulceration, and intussusception. 9,10 Compression[pediatricsconsultantlive.com]
    Pelvic Inflammatory Disease
    • Etiologies for our patient included an appendicle abscess, physiological ovarian cysts, polycystic ovarian syndrome (PCOS), leiomyoma, germ cell tumors, Burkitt lymphoma, pregnancy-related etiologies, and pelvic inflammatory disease. 1-3 Our patient was[consultant360.com]
    • Abdominal mass Oncocytoma, renal ... abdominal mass Ovarian Cancer ... abdominal mass P Pancreatic islet cell tumors (non-functioning tumor) ... abdominal mass Pancreatoblastoma ... abdominal mass Paraomphalocele ... abdominal lump Pelvic Inflammatory[rightdiagnosis.com]
    Pyloric Stenosis
    • Causes: Gastrointestinal See Hepatomegaly in Newborns See Splenomegaly in Newborns Gastrointestinal Duplications Meconium ileus Mesenteric or omental cyst Pyloric Stenosis Volvulus[fpnotebook.com]
    • Causes Upper abdominal/ epigastric mass retroperitoneal lymphadenopathy (e.g. lymphoma, teratoma) AAA gastric CA pancreatic pseudocyst or tumour pyloric stenosis transverse colon CA large recti left lobe of liver Right hypochondrium hepatomegaly enlarged[lifeinthefastlane.com]
    • Antenatal prediction of hypertrophic pyloric stenosis.[contemporaryobgyn.modernmedicine.com]
    • Miscellaneous – e.g. abscess, fecal mass, hydrops of gall bladder, intussusception, pregnancy, pyloric stenosis, hydrometrocolpos, adrenal hemorrhaage, etc.[pediatriceducation.org]
    • stenosis Omental or Mesenteric cyst Physical examination Physical exams in a very young child can be difficult.[learn.pediatrics.ubc.ca]
    Ovarian Cyst
    Intussusception
    • Positive findings for these symptoms can point you to pathologies of the gastrointestinal tract such as intussusception of volvulus.[prezi.com]
    • […] carcinoma (smooth, firm, non-tender mass) Right iliac fossa Actinomycosis Amoebic abscess Appendix mass or abscess Caecal/colon cancer or distension Crohn's disease (multiple tender, sausage-shaped masses) Hernia Ileocaecal mass caused by tuberculosis Intussusception[patient.info]
    • Miscellaneous – e.g. abscess, fecal mass, hydrops of gall bladder, intussusception, pregnancy, pyloric stenosis, hydrometrocolpos, adrenal hemorrhaage, etc.[pediatriceducation.org]
    • Abdominal pain, anorexia, vomiting, anemia, pancreatitis, hypoalbuminemia, and jaundice may be present. 8,9 Reported complications of trichobezoars include intestinal obstruction and perforation, gastric ulceration, and intussusception. 9,10 Compression[pediatricsconsultantlive.com]
    • Positive findings for these symptoms can point you to pathologies of the gastrointestinal tract such as intussusception of volvulus Differential diagnosis Organ Malignant Diseases Nonmalignant Diseases Adrenal Adrenal carcinoma Neuroblastoma Pheochromocytoma[learn.pediatrics.ubc.ca]
    Hemangioma
    • ) - /- cutaneous hemangiomas, can by asymptomatic or cause AV shunting and CHF, can spontaneously regress Part of Kasabach-Merritt syndrome: low platlets, consumptive coagulopathy, hemolytic anemia Treat with steroids, IFN, embolization/resection, or[pedclerk.bsd.uchicago.edu]
    • The most common benign hepatic tumors of infancy are infantile hemangioendothelioma, mesenchymal hamartoma, and infantile hemangioma. 3 Hepatoblastoma is the most common primary malignant hepatic tumor in this age group.[jaocr.org]
    Fecal Impaction
    • Pheochromocytoma Adrenal Adenoma Adrenal Hemorrhage Gall bladder Leiomyosarcoma Choledochal cyst Gall Bladder obstruction Hydrops (eg, leptospirosis) Gastrointestinal tract Leiomyosarcoma Non-Hodgkin lymphoma Appendiceal abscess Intestinal duplication Fecal[learn.pediatrics.ubc.ca]
    • impaction. • Abdominal ultrasound: o Can usually identify the origin of the mass and differentiate between solid and cystic tissue; disadvantages are operator variability and a limited exam when bowel gas obscures underlying abdominal tissues. • CT scan[prezi.com]
    Amnionitis
    • Sectioning of this mass yielded a clear fluid and a foetiform mass with four limbs and a rudimentary umbilical cord measuring 8 mm that extended into a membrane-like tissue that corresponded to the amnion ( Fig. 2 ).[analesdepediatria.org]

    Etiology

    Causes

    Epidemiology

    Sex distribution
    Age distribution

    Pathophysiology

    Prevention

    Summary

    Patient Information

    Other symptoms

    Adenoma
    • Right adrenal differentials include adenocarcinoma or pheochromocytoma given the invasive activity, possible adenoma with attached thrombosis.[sonopath.com]
    • […] for these symptoms can point you to pathologies of the gastrointestinal tract such as intussusception of volvulus Differential diagnosis Organ Malignant Diseases Nonmalignant Diseases Adrenal Adrenal carcinoma Neuroblastoma Pheochromocytoma Adrenal Adenoma[learn.pediatrics.ubc.ca]
    Mesenchymal Hamartoma of the Liver
    • Mesenchymal hamartoma of the liver: a systematic review.[jaocr.org]
    Amiodarone
    • Pyogenic/Amoebic abscesses Neoplasia ( infiltrative disease) Secondaries Primary hepatocellular carcinoma Myeloma, leukaemia, lymphoma Sarcoid/Amyloid Degenerative/Deficiency/Drugs Alcoholic liver disease Drug induced hepatitis (statins, macrolides, amiodarone[dundeemedstudentnotes.wordpress.com]
    Dilated Ureter

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    References

    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.

    1. Acute respiratory failure in multiple sclerosis. - I Kuwahira, T Kondo, Y Ohta, H Yamabayashi - Chest, 1990 - chestjournal.chestpubs.org


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