Abdominal/Pelvic Mass
Abdominal/Pelvic Mass: Excerpt from Field Guide to Bedside Diagnosis
Differential Overview
Abdominal Mass
❑ Liver enlargement
❑ Spleen enlargement
❑ Fecal mass
❑ Diverticulitis
❑ Colon cancer
❑ Gallbladder enlargement
❑ Pancreatic pseudocyst
❑ Crohn disease
❑ Abdominal aortic aneurysm
❑ Renal enlargement
Pelvic Mass
❑ Distended bladder
❑ Pregnant uterus
❑ Salpingitis
❑ Ovarian cyst
❑ Uterine fibromyoma
❑ Ovarian cancer
❑ Endometrial cancer
❑ Ectopic pregnancy
❑ Malignant deposit
Diagnostic Approach
Consider the structures in the region of the mass for clues to its origin and the presence of tenderness as an indicator of inflammation/infection. It is possible to miss initially even a relatively large mass unless a systematic four-quadrant examination is performed.
Clinical Findings
Liver enlargement The liver extends from under the costal margin. Liver metastases feel hard and irregular. In patients with acute hepatitis, the liver is tender and smoothly enlarged.
Spleen enlargement A palpable spleen tip in the left upper quadrant on inspiration signifies splenic enlargement.
Fecal mass It is commonly found in the cecum or sigmoid colon. Firm and mobile, it may disappear completely on repeat exam.
Diverticulitis A boggy, tender, ill-defined mass may be palpable in the left lower quadrant. The patient is febrile.
Colon cancer It presents as a vague fixed mass that is associated with a change in bowel habits and blood in the stool.
Gallbladder enlargement An oval, movable, right upper quadrant mass develops in a patient with a history of episodic intense steady pain (biliary colic).
Pancreatic pseudocyst It appears as a left upper quadrant, smooth, rounded, fixed mass in a patient with a history of recurrent pancreatitis.
Crohn disease A right lower quadrant mass arises from terminal ileum involvement, in conjunction with weight loss and recurrent diarrhea with mucus and blood.
Abdominal aortic aneurysm This is characterized by a central pulsatile mass, often with a harsh bruit. Differentiate an aneurysm from a transmitted aortic impulse by placing the hands parallel along the edge of the mass. If they move apart, it is expansile.
Renal enlargement Palpated in the lateral abdomen, an irregular nodular mass associated with intermittent profuse hematuria with pyramidal clots will signify renal cancer. Renal cancer may be associated with the sudden appearance of a left scrotal varicocele.
Distended bladder A smooth mass arises over the pelvic brim. There will usually be a prominent urge to void.
Pregnant uterus Suspect when the menstrual period is missed, and look for other signs of pregnancy, such as nausea, darkening of the areola, bluish cervix, and globular uterine enlargement.
Salpingitis Fever, progressive abdominal pain, and an exquisitely tender, fixed adnexal swelling are found. Lateral traction of the cervix during the pelvic exam will cause pain (chandelier sign).
Ovarian cyst The menses are normal. The mass can be separated from the uterus on bimanual exam.
Uterine fibromyoma Menorrhagia is common, except in subperiosteal tumors. Masses are irregular and attached to the uterus.
Ovarian cancer Fixation of the mass in the pelvis, ascites with abdominal distension, unilateral leg edema, cachexia, and abdominal pain are clues.
Endometrial cancer Irregular bleeding is the primary sign.
Ectopic pregnancy Before rupture, a mildly tender adnexal mass will appear. Other signs include a missed period or irregular, spotty bleeding. With tubal rupture, there will be sudden pain, hypotension, and an ill-defined lateral mass.
Malignant deposit It will be palpable through the rectum as a firm, shelf-like impression.
Book Source Details
- Book Title: Field Guide to Bedside Diagnosis
- Author(s): David S. Smith
- Year of Publication: 2007
- Copyright Details: Field Guide to Bedside Diagnosis, Copyright © 2007 Lippincott Williams & Wilkins.
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Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.
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More About This Book:
Title: Field Guide to Bedside Diagnosis
Authors: David S. Smith
Publisher: Lippincott Williams & Wilkins
Copyright: 2007
ISBN: 0-78178-165-5
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