Abdominal and pelvic masses manifest as swellings in specific areas of the abdomen and pelvis. They are often incidentally picked up on physical examination. Most causes of abdominal masses are benign, but some might indicate a serious underlying pathology.
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General Surgery - Abdominal and Pelvic Masses: What You Cannot Afford to Miss
Whiteboard Animation Transcript
with Roy Kirkpatrick, MD
medskl.com/Mod...
Abdominal masses manifest as swellings in a specific area of the abdomen. The location, texture, and associated symptoms can provide clues to etiology. Here is an approach to a patient with an abdominal mass and some conditions that you cannot afford to miss.
Remember that the abdomen can be divided into 4 quadrants. If you keep in mind the anatomical structures in each quadrant, your list of differentials will be more focused.
A mass in the upper right quadrant can represent gallbladder or liver pathology. Tenderness on palpation usually indicates an infectious process of either organ. Firm, lumpy, or irregular masses can suggest more serious pathology, such as cancer, and should be
investigated immediately.
A mass in the left upper quadrant should raise concern for splenomegaly. This can be due to infection, liver disease, or cancer.
Masses in the right and left lower quadrants can indicate colon cancer. Consider this in patients who also complain of unintentional weight loss or have a family history of colon cancer or who have bowel dysfunction.
A midline expansile and pulsatile mass should have you thinking about an abdominal aortic aneurysm. Investigate using an ultrasound, as these have a risk of rupturing and causing life threatening bleeds.
A mass in the lower midline can be due to bladder distension or bladder tumour. Consider this in a patient with decreased urine output or gross hematuria.
Finally, keep in mind that gynecological conditions can cause abdominal and pelvic masses in women. Right and left lower quadrant masses can be due to ectopic pregnancy, ovarian cysts, or tumours. Lower midline masses can indicate fibroids or neoplasms in the uterus. And don’t forget to rule out pregnancy in any woman of childbearing age!