RIGHT LOWER QUADRANT MASS

RIGHT LOWER QUADRANT MASS: Excerpt from Differential Diagnosis in Primary Care

Anatomy is once again the key to developing a differential diagnosis of a right lower quadrant (RLQ) mass. Underneath the skin, subcutaneous tissue, fascia, and muscle, lie the cecum, appendix, terminal ileum, iliac artery and vein, and ileum. In the female, the fallopian tube and ovary should be included. Occasionally a ptosed kidney also will be felt here. Now, apply the etiologic mnemonic MINT to each organ, and you should have a reliable differential diagnosis, like that in Table 3. The important lesions to remember here are the following:

1. M—Malformations such as inguinal and femoral hernias may be present.
2. I—Inflammations include acute appendicitis with abscess, tubo-ovarian abscesses, and regional ileitis.
3. N—Neoplasms to be considered in this area are carcinoma of the cecum and ovarian tumors.
4. T—Traumatic lesions include fracture or contusion of the ileum and perforation of the bowel from a stab wound.

ABDOMINAL MASS, RLQ

The lymph nodes may be involved with tuberculosis or actinomycosis. The cecum may also be enlarged by accumulation of Ascaris or other parasites. The omentum can contribute to adhesions of the bowel to form a mass or it may develop cysts.

Approach to the Diagnosis

As with other abdominal masses, its important to look for other symptoms and signs that will help determine the origin of the mass. If there are fever and chills, an appendiceal or diverticular abscess is possible. Blood in the stools suggests a diagnosis of colon carcinoma. If there is amenorrhea or vaginal bleeding in a woman of childbearing age, an ectopic pregnancy most be considered. A long history of chronic diarrhea with or without blood in the stools suggests Crohn disease.

The initial workup will include a CBC, sedimentation rate, chemistry panel, stool for occult blood, pregnancy test, and flat plate of the abdomen. If there is fever and an acute presentation, consultation with a general surgeon to consider an immediate exploratory laparotomy is indicated.

With a more insidious onset of the RLQ mass, the clinician has a choice of ordering a CT scan of the abdomen and pelvis after performing the initial diagnostic studies or proceeding systematically with a barium enema, IVP, or small-bowel series to determine the origin of the mass. A gastroenterology or gynecology consult may be the best way to resolve this dilemma.

Other Useful Tests

1. Sonogram (ectopic pregnancy)
2. Peritoneal tap (ruptured ectopic, peritoneal abscess)
3. Colonoscopy (colonic neoplasm)
4. Serum protein electrophoresis (plasmacytoma)
5. Indium scan (peritoneal abscess)
6. Aortogram (aortic aneurysm)
7. Lymphangiogram (retroperitoneal tumor)
8. Laparoscopy (neoplasm, ectopic pregnancy)

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.

More About Osteoporosis

• Back to disease: Osteoporosis: Introduction
• Next Book Extract About Osteoporosis: Low birth weight (Handbook of Signs & Symptoms (Third Edition))
• More Book Extracts: All Online Books for Osteoporosis

More Medical Textbooks Online about Osteoporosis

Review other book chapters online related to Osteoporosis:

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

 » Next page: Low birth weight (Handbook of Signs & Symptoms (Third Edition))

Rate This Website

What do you think about the features of this website? Take our user survey and have your say:

Website User Survey

Medical Tools & Articles:

Next articles:

• Low birth weight (Handbook of Signs & Symptoms (Third Edition))
• Osteoporosis* (A Pocket Manual of Differential Diagnosis)
• Anemia: Hypoproliferative (Low Reticulocyte Count) (A Pocket Manual of Differential Diagnosis)
• Mediastinal Masses by Predominant Compartment (A Pocket Manual of Differential Diagnosis)
• Osteoporosis (Professional Guide to Diseases (Eighth Edition))

Tools & Services:

• Bookmark this page
• Symptom Search
• Symptom Checker
• Medical Dictionary
• Give your feedback

Medical Articles:

• Disease & Treatments Search
• Misdiagnosis Center
• Full list of interesting articles

Forums & Message Boards

• Ask or answer a question at the Boards:
• I cannot get a diagnosis. Please help.
• Tell us your medical story.
• Share your misdiagnosis story.
• What is the best treatment for my condition?
• See all the Boards.

Enter your search terms Submit search form
Search The Web Search wrongdiagnosis.com

Common Health Mistakes

Symptom
Checker

Search Specialists by State and City