Abdominal mass

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

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.

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.

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

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

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

• Abdominal aortic aneurysm
• Bladder distention
• Cholecystitis
• Colon cancer
• Crohn’s disease
• Bowel obstruction
• Diverticulitis
• Gallbladder tumor
• Hydronephrosis
• Kidney cancer
• Liver cancer
• Hepatomegaly
• Neuroblastoma
• Ovarian cyst
• Pancreatic abscess
• Pancreatic pseudocyst
• Splenomegaly
• Stomach cancer
• Uterine leiomyoma
• Volvulus
• Uretero-pelvic junction obstruction

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• Abdominal aortic aneurysm can cause a pulsating mass around the navel.
• Bladder distention (urinary bladder over-filled with fluid) can cause a firm mass in the center of the lower abdomen above the pelvic bones, in extreme cases it can reach as far up as the navel.
• Cholecystitis can cause a very tender mass that is felt below the liver in the right-upper quadrant (occasionally).
• Colon cancer and Volvulus can cause a mass at any location in the abdomen.
• Crohn’s disease or bowel obstruction can cause many tender, sausage-shaped masses anywhere in the abdomen.
• Diverticulitis can cause a mass that is usually located in the left-lower quadrant.
• Gallbladder tumor can cause a tender, irregularly shaped mass in the right-upper quadrant.
• Hydronephrosis (fluid-filled kidney) can cause a smooth, spongy-feeling mass in one or both sides or toward the back (flank area).
• Kidney cancer can sometimes cause a mass in the abdomen.
• Liver cancer can cause a firm, lumpy mass in the right upper quadrant.
• Liver enlargement (hepatomegaly) can cause a firm, irregular mass below the right rib cage, or on the left side in the stomach area.
• Neuroblastoma, a cancerous tumor, often found in the lower abdomen, that mainly occurs in children and infants.
• Ovarian cyst can cause a smooth, rounded, rubbery mass above the pelvis in the lower abdomen.
• Pancreatic abscess can cause a mass in the upper abdomen in the epigastric area.
• Pancreatic pseudocyst can cause a lumpy mass in the upper abdomen in the epigastric area.
• Renal cell carcinoma can cause a smooth, firm, but not tender mass near the kidney (usually only affects one kidney).
• Spleen enlargement (splenomegaly) can sometimes be felt in the left-upper quadrant.
• Stomach cancer can cause a mass in the left-upper abdomen in the stomach area (epigastric) if the cancer is large.
• Uterine leiomyoma (fibroids) can cause a round, lumpy mass above the pelvis in the lower abdomen (sometimes can be felt if the fibroids are large).
• Ureteropelvic junction obstruction can cause a mass in the lower abdomen.
• Intramural mass (Rectus hematoma) can present as a mass in the abdominal area, but can be distinguished with physical examination. Ask the patient to lift his head up from pillow and palpate the mass. When the abdominal muscles get tensed, the abdominal mass moves away while the intramural mass can still be palpable.^[1]
• [[category:Needs review]]

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Many abdominal masses are discovered incidentally during routine physical examination. When they are 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.

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