BACK MASS

BACK MASS: Excerpt from Differential Diagnosis in Primary Care

It is not uncommon for a patient to complain of a lump on his or her back. Most of the time the lesion is a sebaceous cyst or lipoma. However, there are other types of back masses, and a simple method of recall is needed. Anatomy is the key. If the mnemonic MINT is applied to most of these structures, all of the important lesions can be recalled.

1. Skin
   1. M—Malformations include pilonidal cysts and sebaceous cysts.
   2. I—Inflammation suggests carbuncles and furuncles.
   3. N—Neoplasms include hemangiomas, neurofibromas, lipomas, and metastatic tumors.
   4. T—Trauma, of course, suggests contusions.
2. Subcutaneous tissue and fascia
   1. M—Malformations include hernias of Petit triangle.
   2. I—Inflammatory suggests lesions such as rheumatoid nodules and abscesses.
   3. N—Neoplasms encompass those mentioned above.
   4. T—Trauma includes contusions and lacerations. Anasarca may produce edema of the back.
3. Muscle. Muscle is frequently nodular in fibromyositis and a bursa may occasionally swell significantly. Rupture of a muscle or ligament and contusions are traumatic lesions that may present a mass. Muscle spasm from back injuries is often significant enough to cause a “mass.”
4. Bone. Lesions of the bone are usually responsible for the deeper masses in the back.
   1. M—Malformations include spina bifida, which may be occult or manifest as a swelling such as meningocele or meningomyelocele.
   2. I—Inflammation suggests the gibbus of Pott disease (tuberculosis of the spine).
   3. N—Neoplasm suggests metastatic neoplasm and multiple myeloma of the spine which may protrude from beneath the skin.
   4. T—Trauma suggests the obvious mass of a fracture dislocation or hematoma of the periosteum of the spine.
5. Retroperitoneal structure. Wilms tumors of the kidney and perinephric abscesses may present as a mass in the back.

BACK MASS

Approach to the Diagnosis

With skin lesions, excision or biopsy is frequently the best approach. Masses of the deeper structures cannot be approached as aggressively until certain conditions have been ruled out by computed tomography (CT) scans and bone scans. If a meningocele or similar congenital lesion is suspected, a neurosurgeon must be consulted.

Other Useful Tests

1. X-ray of the thoracic or lumbosacral spine (malformations, neoplasm)
2. MRI of the thoracic or lumbar spine (malformation, neoplasm)
3. IVP (Wilms tumor, perinephric abscess)
4. Tuberculin test
5. Serum protein electrophoresis (multiple myeloma)
6. Myelogram
7. Exploratory surgery

Book Source Details

• Book Title: Differential Diagnosis in Primary Care
• Author(s): R. Douglas Collins
• Year of Publication: 2007
• Copyright Details: Differential Diagnosis in Primary Care, Copyright © 2007 Lippincott Williams & Wilkins.

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Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.

More About This Book: Title: Differential Diagnosis in Primary Care Authors: R. Douglas Collins Publisher: Lippincott Williams & Wilkins Copyright: 2007 ISBN: 0-7817-6812-8

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