Abdominal mass

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Abdominal mass Classification and external resources
This infant has massive hepatomegaly due to metastatic neuroblastoma. Intra-abdominal pressure is partially relieved by a silastic pouch. Image courtesy of Professor Peter Anderson DVM PhD and published with permission © PEIR, University of Alabama at Birmingham, Department of Pathology

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An abdominal mass is any localized enlargement or swelling in the human abdomen. Depending on its location, the abdominal mass may be caused by an enlarged liver (hepatomegaly), enlarged spleen (splenomegaly), protruding kidney, a pancreatic mass, a retroperitoneal mass (a mass in the posterior of the peritoneum), an abdominal aortic aneurysm, or various tumours, such as those caused by abdominal carcinomatosis and omental metastasis. The treatments depend on the cause, and may range from watchful waiting to radical surgery.

Features

Many abdominal masses are discovered incidentally during routine physical examination. When they present symptomatically, abdominal masses are most frequently associated with pain or digestive problems. However, depending on the cause, masses may be associated with other signs and symptoms, such as jaundice or bowel obstruction.

Diagnosis

The first steps in diagnosis are a medical history and physical examination. Important clues during history include weight loss, diarrhea and abdominal pain.

During physical examination, the clinician must identify the location of the mass, as well as characterize its location (usually specified in terms of quadrants). The mass should be assessed for whether it is rigid or mobile. It should also be characterized for pulse or peristalsis, as these would help in further identifying the mass.

Routine blood tests are usually the next step in diagnosis after a thorough medical history and physical examination. They should include a full blood count, blood urea nitrogen (BUN), creatinine, and liver function tests such as albumin, international normalized ratio (INR), partial thromboplastin time (PTT), serum amylase and total bilirubin (TBIL). If late-stage liver disease is suspected, then a serum glucose may be appropriate.

Physical Examination

• Associated symptoms:

  • Rectal bleeding
  • Weight change
  • Urinary symptoms
  • Fever
  • Changes in bowel habits

Abdomen

• Examine abdomen for areas of tenderness

Other

• Examine pelvis for areas of tenderness

Laboratory Findings

• Blood urea nitrogen (BUN)/creatinine
• Complete blood count (CBC)
• LFTs (liver function tests)
• Urinalysis
• Beta-human chorionic gonadotrophin

Electrolyte and Biomarker Studies

• Electrolytes
• Tumor markers (if concern is malignancy)
• Toxicology screen
• Blood culture (if concern is infection)

X Ray

• KUB (kidneys, ureters, bladder) x-rays could possibly reveal free intraperitoneal air, constipation or obstruction.

MRI and CT

• Abdominal CT with oral IV contrast will evaluate for bowel pathology, abscess, and hepatosplenomegaly

Other Diagnostic Studies

• Laparoscopy of the intra-abdominal cavity allows for direct visualization
• Colonoscopy helps in the diagnosis of bowel pathology
• Paracentesis with fluid evaluation.

Causes

In alphabetical order. ^{[1] [2]}

• Abdominal aortic aneurysm
• Abdominal neoplasms
• Abdominal swelling
• Abruptio placentae
• Acute Cholecystitis
• Adenocarcinoid tumor
• Alveolar hydatid disease
• Appendicitis - an abdominal mass may occur but is not a common symptom of appendicitis.
• Bezoar
• Biliary atresia
• Bladder distention
• Bowel obstruction
• Burkitt's lymphoma
• Carcinoid tumours and carcinoid syndrome
• Childhood liver cancer, primary
• Cholecystitis
• Choledochal cyst
• Cholelithiasis
• Choriocarcinoma
• Chromophil renal cell carcinoma
• Chromophobe renal cell carcinoma
• Chronic myeloid leukemia
• Cirrhosis of the liver
• Clear cell renal carcinoma
• Colonic diverticulitis
• Colorectal cancer
• Constipation
• Crohn's disease
• Desmoid disease, hereditary
• Desmoplastic small round cell tumor
• Digestive system cancer
• Diverticulitis
• Endodermal sinus tumor
• Enlarged gallbladder
• Enlarged kidney
• Enlarged pancreas
• Enlarged uterus
• Extragonadal Germ Cell Tumor
• Femoral hernia
• Florid cystic endosalpingiosis of the uterus
• Gallbladder cancer
• Gallbladder empyema
• Gastric lymphoma
• Gastro-enteropancreatic neuroendocrine tumor
• Gastrointestinal Basidiobolomycosis
• Gastrointestinal neoplasm
• Hamartoma of lung and kidney
• Hemangioendothelioma
• Hemangiopericytoma
• Hepatic adenoma
• Hepatitis
• Hepatoblastoma
• Hepatomegaly
• Hirschsprung's disease
• Hydatid disease
• Hydronephrosis (fluid-filled kidney)
• Immunoproliferative diseases
• Inflammatory myofibroblastic tumors
• Inguinal hernia
• Intususception of intestine
• Kala-azar
• Kaposiform hemangio-endothelioma
• Kidney cancer (including renal cell carcinoma)
• Krukenberg tumor
• Large bowel obstruction
• Leiomyoma, gastric
• Leiomyosarcoma
• Lipomatous hemangiopericytoma
• Liver cancer
• Lymphoma gastric non-Hodgkins type
• Malaria
• McKusick-Kaufman syndrome
• Megaureter
• Mesothelioma, adult malignant
• Mucosal-associated lymphoid tissue lymphoma
• Multicystic renal dysplasia, bilateral
• Myelofibrosis
• Necrotizing enterocolitis
• Nephroblastoma
• Nephroma
• Neurilemmoma
• Neuroblastoma
• Neurofibromatosis
• Non functioning pancreatic endocrine tumor
• Non-Hodgkin's lymphoma
• Oesophagostomiasis
• Oncocytoma, renal
• Ovarian cancer
• Ovarian cyst
• Pancreatic abscess
• Pancreatic cancer
• Pancreatic islet cell tumors (non-functioning tumor)
• Pancreatic pseudocyst
• Pancreatitis
• Pancreatoblastoma
• Paraomphalocele
• Pelvic Inflammatory Disease
• Peritoneal adhesions
• Peritonitis
• Pheochromocytoma
• Plexosarcoma
• Polycystic kidney disease
• Pseudomyxoma peritonei
• Rectal cancer
• Renal adenocarcinoma
• Renal cancer
• Renal oncocytoma
• Renal transplantation
• Retroperitoneal liposarcoma
• Rhabdoid tumor
• Riedel lobe of liver
• Sister Mary Joseph nodule
• Small bowel lymphoma
• Small bowel obstruction
• Small intestine cancer
• Spleen cancer
• Splenomegaly
• Splenosis
• Stomach cancer
• Swollen bladder
• Toxic megacolon
• Transitional cell carcinoma
• Umbilical hernia
• Urachal cyst
• Ureter cancer
• Ureteropelvic junction obstruction
• Urethral cancer
• Urinary obstruction
• Urinary tract neoplasm
• Urine retention
• Uterine cancer
• Uterine enlargement
• Uterine leiomyoma (fibroids)
• Volvulus (twisted piece of the gastrointestinal tract)
• WAGR Syndrome
• Wandering spleen
• Wilms' tumor
• Xanthogranulomatous cholecystitis
• Yersinia enterocolitica

Complete Differential Diagnosis of Causes of Abdominal mass

Epiphenomena

• Sister Mary Joseph nodule

Miscellaneous syndromes

• Pancreatic pseudocyst

Symptoms and Signs

• Constipation
• Urine retention
• Uterine enlargement

Congenital conditions

• Congenital hypertrophic pyloric stenosis
• Hirschsprung disease
• Riedel lobe of liver
• Urachal cyst
• Wandering spleen

Autosomal dominant conditions

• Polycystic kidney disease, adult (autosomal dominant)

Autosomal recessive conditions

• Polycystic kidney disease, autosomal recessive

Cardiac and vascular conditions

• Aortic aneurysm, abdominal

Autoimmune conditions

• Crohn disease

Inflammatory conditions

• Colonic diverticulitis
• Toxic megacolon

Neoplastic conditions

• Carcinoid tumours and carcinoid syndrome
• Mucosal-associated lymphoid tissue lymphoma
• Neuroblastoma
• Phaeochromocytoma
• Pseudomyxoma peritonei

Benign neoplastic conditions

• Hepatic adenoma
• Leiomyoma, gastric
• Neurilemmoma
• Renal oncocytoma

Malignant neoplastic conditions

• Colorectal cancer
• Endodermal sinus tumor
• Gallbladder cancer
• Hepatoblastoma
• Krukenberg tumor
• Liver cancer, primary
• Nephroblastoma
• Non-Hodgkin lymphoma
• Pancreatic cancer
• Renal adenocarcinoma
• Small bowel lymphoma
• Stomach cancer

Trauma, mechanical and physical conditions

• Bezoar
• Choledochal cyst
• Cholelithiasis
• Intususception of intestine
• Large bowel obstruction
• Peritoneal adhesions
• Small bowel obstruction
• Splenosis

Infection and infective conditions

• Gallbladder empyema

Helminths and helminthic conditions

• Alveolar hydatid disease
• Oesophagostomiasis

Bacteria and bacterial conditions

• Yersinia enterocolitica

Iatrogenic conditions

• Renal transplantation

Other Causes:

• Abdominal aortic aneurysm
• Ascites

  • Possibly due to liver disease, congestive heart failure, malignancy, nephrotic syndrome

• Bladder distention
• Bowel obstruction
• Cholecystitis
• Chron's Disease
• Constipation/difficulty passing stool

  • Medications: Opiates, anticholinergic medications, narcotics
  • Most commonly due to low dietary fiber intake and/or dehydration
  • Ogilvie's Syndrome
  • Hirschsprung's Disease

• Cyst
• Diverticulitis
• Hepatomegaly

  • Dermoid cyst: Delayed presentation could be cause of massive size
  • Mesenteric cyst: Typically benign. Collections of fluid in the mesentery.
  • Hydatid cyst: Typically found in the livers of patients who have traveled to tropical areas. Caused by the larval form of Echinococcus granulosus."

• Hydronephrosis
• Large or small bowel obstruction
• Ovarian cyst
• Palpable gallbladder (Courvoisier's sign)

  • Associated with a distended gallbladder and a common bile duct obstruction

• Pancreatic abscess
• Pancreatic pseudocyst
• Ureteropelvic junction obstruction
• Soft tissue mass

  • Abdominal aortic aneurysm: Associated with hypotension and a pulsatile mass
  • Hernia: Incarceration causes pain; strangulation leads to death of bowel. Bowel sounds may be heard over mass.
  • Infection: Tubo-ovarian or intra-abdominal abscess
  • Lipoma: Mobile, soft, fleshy, contained in abdominal wall within the subcutaneous tissue
  • Massive lymphadenopathy
  • Organomegaly
  • Pregnancy
  • Pyloric stenosis: Palpable pyloric olive-shaped mass, primarily seen in infants

• Tumor:

  • Colon cancer
  • Liver cancer
  • Stomach cancer
  • Kidney cancer
  • Gallbladder tumor
  • Neuroblastoma
  • Uterine leiomyoma (fibroids)

• Volvulus
• Ureteropelvic junction obstruction

Treatment

• Immediately treat life-threatening causes (such as abdominal aortic aneurysms).
• Organomegaly typically resolves once the underlying etiology is treated.

Acute Pharmacotherapies

• Ogilvie's syndrome responds to decompression by IV neostigmine or by a rectal tube
• Constipation is usually treated with laxatives, increased dietary fiber and fluids, enemas.

  • Manual disimpaction is reserved for fecal impaction.
  • Stop use of offending medications.

• Masses caused by infections require antibiotics (and possible surgery)

Surgery and Device Based Therapy

• Several benign and malignant masses require surgical intervention
• Hirschsprung's disease often requires surgery.

References

Additional Resources

• MedlinePlus medical encyclopedia: Abdominal mass - An informative primer on abdominal masses and their common causes.
• First Principles of Gastroenterology: Abdominal Mass - This chapter discusses the basic approach to abdominal masses.

Acknowledgements

The content on this page was first contributed by Editor-In-Chief: C. Michael Gibson, M.S., M.D. [3] Phone:617-525-6884

v • d • e WikiDoc Research Resources for Abdominal mass (Click show to right to view)
Articles on Abdominal mass	Most recent articles on Abdominal mass • Most cited articles on Abdominal mass • Review articles on Abdominal mass • Articles on Abdominal mass in N Eng J Med, Lancet, BMJ
Media (Slides, Video, Images, MP3) on Abdominal mass	Powerpoint slides on Abdominal mass • Images of Abdominal mass • Photos of Abdominal mass • Podcasts & MP3s on Abdominal mass • Videos on Abdominal mass
Evidence Based Medicine Regarding Abdominal mass	Cochrane Collaboration on Abdominal mass • Bandolier on Abdominal mass • TRIP on Abdominal mass
Cost Effectiveness of Abdominal mass	Cost Effectiveness of Abdominal mass
Clinical Trials Involving Abdominal mass	Ongoing Trials on Abdominal mass at Clinical Trials.gov • Trial results on Abdominal mass • Clinical Trials on Abdominal mass at Google
Guidelines / Policies / Government Resources (FDA/CDC) Regarding Abdominal mass	US National Guidelines Clearinghouse on Abdominal mass • NICE Guidance on Abdominal mass • NHS PRODIGY Guidance • FDA on Abdominal mass • CDC on Abdominal mass
Textbook Information on Abdominal mass	Books and Textbook Information on Abdominal mass
Pharmacology Resources on Abdominal mass	Dosing of Abdominal mass • Drug interactions with Abdominal mass • Side effects of Abdominal mass • Allergic reactions to Abdominal mass • Overdose information on Abdominal mass • Carcinogenicity information on Abdominal mass • Abdominal mass in pregnancy • Pharmacokinetics of Abdominal mass •
Genetics, Pharmacogenomics, and Proteinomics of Abdominal mass	Genetics of Abdominal mass • Pharmacogenomics of Abdominal mass • Proteomics of Abdominal mass
Newstories on Abdominal mass	Abdominal mass in the news • Be alerted to news on Abdominal mass • News trends on Abdominal mass
Commentary on Abdominal mass	Blogs on Abdominal mass
Patient Resources on Abdominal mass	Patient resources on Abdominal mass • Discussion groups on Abdominal mass • Patient Handouts on Abdominal mass • Directions to Hospitals Treating Abdominal mass • Risk calculators and risk factors for Abdominal mass
Healthcare Provider Resources on Abdominal mass	Symptoms of Abdominal mass • Causes & Risk Factors for Abdominal mass • Diagnostic studies for Abdominal mass • Treatment of Abdominal mass
Continuing Medical Education (CME) Programs on Abdominal mass	CME Programs on Abdominal mass
International Resources on Abdominal mass	Abdominal mass en Espanol • Abdominal mass en Francais
Business Resources on Abdominal mass	Abdominal mass in the Marketplace • Patents on Abdominal mass
Informatics Resources on Abdominal mass	List of terms related to Abdominal mass

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Acknowledgement and Attribution Regarding Sources of Content

Some of the initial content on this page may be incorporated in part from copyleft sources in the public domain including wikis such as Wikipedia and AskDrWiki. Drug information for patients came from the The National Library of Medicine. Infectious disease information may have come from the Centers for Disease Control (CDC). Differential Diagnoses are drawn from clinicians as well as an amalgamation of 3 sources: 1.The Disease Database; 2. Kahan, Scott, Smith, Ellen G. In A Page: Signs and Symptoms. Malden, Massachusetts: Blackwell Publishing, 2004:3; 3. Sailer, Christian, Wasner, Susanne. Differential Diagnosis Pocket. Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:7 .