Abdominal mass resident survival guide: Difference between revisions
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*The following chart illustrates the probable causes of an abdominal mass based on the location and salient features. | *The following chart illustrates the probable causes of an abdominal mass based on the location and salient features. | ||
{{familytree/start|summary=Abdominal mass causes.}} | {{familytree/start|summary=Abdominal mass causes.}} | ||
{{familytree | {{familytree | | | | | | | A01 | | | A01='''Causes of abdominal mass'''<ref name="urlACS/ASE Medical Student Core Curriculum">{{cite web |url=https://www.facs.org/education/program/core-curriculum#:~:text=The%20American%20College%20of%20Surgeons,school%20faculty%2C%20and%20clinical%20faculty. |title=ACS/ASE Medical Student Core Curriculum |format= |work= |accessdate=}}</ref>}} | ||
{{familytree | {{familytree | | | | | | | |!| | | | }} | ||
{{familytree | {{familytree | | | | | |,|-|^|-|.| | | | }} | ||
{{familytree | {{familytree | | | | | |!| | | |!| | | |}} | ||
{{familytree | {{familytree | | | | | C01 | | C02 | | | |C01=<div style="float: left; text-align: left; width: 22em; padding:1em;">'''Abdominal wall mass'''<ref name="pmid24378391">{{cite journal |vauthors=Jo VY, Fletcher CD |title=WHO classification of soft tissue tumours: an update based on the 2013 (4th) edition |journal=Pathology |volume=46 |issue=2 |pages=95–104 |date=February 2014 |pmid=24378391 |doi=10.1097/PAT.0000000000000050 |url=}}</ref><ref name="pmid31867236">{{cite journal |vauthors=Li M, Zhang L, Xu XJ, Shi Z, Zhao XM |title=CT and MRI features of tumors and tumor-like lesions in the abdominal wall |journal=Quant Imaging Med Surg |volume=9 |issue=11 |pages=1820–1839 |date=November 2019 |pmid=31867236 |pmc=6902146 |doi=10.21037/qims.2019.09.03 |url=}}</ref><br> | ||
❑Primary tumors ([[WHO]] classification)<br> | ❑Primary tumors ([[WHO]] classification)<br> | ||
:❑[[Adipocyte|Adipocytic]] tumors ([[lipoma]], [[liposarcoma]]) <br> | :❑[[Adipocyte|Adipocytic]] tumors ([[lipoma]], [[liposarcoma]]) <br> | ||
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:❑[[Endometriosis]], [[abscess]], [[hematoma]]<br> | :❑[[Endometriosis]], [[abscess]], [[hematoma]]<br> | ||
:❑[[Hernia]]s ([[epigastric hernia|epigastric]], [[umbilical hernia|umbilical]], [[incisional hernia|incisional]], and [[spigelian hernia|spigelian]])| C02='''Intra-abdominal/<br> [[retroperitoneal]] mass''' }} | :❑[[Hernia]]s ([[epigastric hernia|epigastric]], [[umbilical hernia|umbilical]], [[incisional hernia|incisional]], and [[spigelian hernia|spigelian]])| C02='''Intra-abdominal/<br> [[retroperitoneal]] mass''' }} | ||
{{familytree | {{familytree | | | | | | | | |!| | |}} | ||
{{familytree | {{familytree | | | | | | | | |!| |}} | ||
{{familytree | | |,|-|-|-|v | {{familytree | | |,|-|-|-|v|-|+|-|-|-|v|-|-|-|.| }} | ||
{{familytree | | |!| | | |! | {{familytree | | |!| | | |!| |!| | | |!| | | |!| |} | ||
{{familytree | | D01 | | D02| | {{familytree | | D01 | | D02 |!| | D04 | | D05 |D01=<div style="float: left; text-align: left; width: 18em; padding:1em;">'''Hepatic mass'''<ref name="pmid20955964">{{cite journal |vauthors=vom Dahl S, Mengel E |title=Lysosomal storage diseases as differential diagnosis of hepatosplenomegaly |journal=Best Pract Res Clin Gastroenterol |volume=24 |issue=5 |pages=619–28 |date=October 2010 |pmid=20955964 |doi=10.1016/j.bpg.2010.09.001 |url=}}</ref><ref name="pmid3003936">{{cite journal |vauthors=Maharaj B, Cooppan RM, Maharaj RJ, Desai DK, Ranchod HA, Siddie-Ganie FM, Goqwana MB, Ganie AS, Gaffar MS, Leary WP |title=Causes of hepatomegaly at King Edward VIII Hospital, Durban. A prospective study of 240 black patients |journal=S. Afr. Med. J. |volume=69 |issue=3 |pages=183–4 |date=February 1986 |pmid=3003936 |doi= |url=}}</ref><br> | ||
❑[[Hepatitis]] (infectious, [[DILI]], [[Alcoholic liver disease|alcoholic]],<br> [[NASH]], [[autoimmune hepatitis|autoimmune]], [[Wilson's disease]]<br> | ❑[[Hepatitis]] (infectious, [[DILI]], [[Alcoholic liver disease|alcoholic]],<br> [[NASH]], [[autoimmune hepatitis|autoimmune]], [[Wilson's disease]]<br> | ||
❑Storage diseases ([[glycogen storage disease]], [[lysosomal storage disease]], [[lipid storage disease]], [[hemochromatosis]])<br> | ❑Storage diseases ([[glycogen storage disease]], [[lysosomal storage disease]], [[lipid storage disease]], [[hemochromatosis]])<br> | ||
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❑[[Cholestasis]] ([[Primary biliary cirrhosis|PBC]], [[Primary sclerosing cholangitis|PSC]]) | D02=<div style="float: left; text-align: left; width: 18em; padding:1em;">'''Splenic mass'''<ref name="pmid29135986">{{cite journal |vauthors=Curovic Rotbain E, Lund Hansen D, Schaffalitzky de Muckadell O, Wibrand F, Meldgaard Lund A, Frederiksen H |title=Splenomegaly - Diagnostic validity, work-up, and underlying causes |journal=PLoS ONE |volume=12 |issue=11 |pages=e0186674 |date=2017 |pmid=29135986 |pmc=5685614 |doi=10.1371/journal.pone.0186674 |url=}}</ref><br>❑[[Infections|Infectious]] ([[Infectious Mononucleosis|IM]], [[liver abscess]], [[echinococcosis]])<br>❑[[Myeloproliferative disorders|Myeloproliferative]] ([[lymphoma]]s<br> and [[leukemia]]s)<br> | ❑[[Cholestasis]] ([[Primary biliary cirrhosis|PBC]], [[Primary sclerosing cholangitis|PSC]]) | D02=<div style="float: left; text-align: left; width: 18em; padding:1em;">'''Splenic mass'''<ref name="pmid29135986">{{cite journal |vauthors=Curovic Rotbain E, Lund Hansen D, Schaffalitzky de Muckadell O, Wibrand F, Meldgaard Lund A, Frederiksen H |title=Splenomegaly - Diagnostic validity, work-up, and underlying causes |journal=PLoS ONE |volume=12 |issue=11 |pages=e0186674 |date=2017 |pmid=29135986 |pmc=5685614 |doi=10.1371/journal.pone.0186674 |url=}}</ref><br>❑[[Infections|Infectious]] ([[Infectious Mononucleosis|IM]], [[liver abscess]], [[echinococcosis]])<br>❑[[Myeloproliferative disorders|Myeloproliferative]] ([[lymphoma]]s<br> and [[leukemia]]s)<br> | ||
❑Storage ([[Gaucher’s disease|Gaucher's]], [[Niemann-Pick disease]])<br>❑Infiltrative:[[amyloidosis]], [[sarcoidosis]]<br> | ❑Storage ([[Gaucher’s disease|Gaucher's]], [[Niemann-Pick disease]])<br>❑Infiltrative:[[amyloidosis]], [[sarcoidosis]]<br> | ||
❑Miscellineous ([[Portal hypertension|PH]], [[metastases]] ([[lung cancer]] or [[breast cancer]], [[Felty's syndrome | ❑Miscellineous ([[Portal hypertension|PH]], [[metastases]] ([[lung cancer]] or [[breast cancer]], [[Felty's syndrome]])| D04=<div style="float: left; text-align: left; width: 18em; padding:1em;">'''[[Gastrointestine|GI]] and [[Genitourinary system|Genitourinary]] mass'''<ref name="pmid18300338">{{cite journal |vauthors=Maconi G, Manes G, Porro GB |title=Role of symptoms in diagnosis and outcome of gastric cancer |journal=World J. Gastroenterol. |volume=14 |issue=8 |pages=1149–55 |date=February 2008 |pmid=18300338 |pmc=2690660 |doi=10.3748/wjg.14.1149 |url=}}</ref><ref name="pmid22272565">{{cite journal |vauthors=Sharma A, Naraynsingh V |title=Distended bladder presenting with constipation and venous obstruction: a case report |journal=J Med Case Rep |volume=6 |issue= |pages=34 |date=January 2012 |pmid=22272565 |pmc=3398309 |doi=10.1186/1752-1947-6-34 |url=}}</ref><ref name="pmid15361501">{{cite journal |vauthors=Caricato M, Ausania F, Borzomati D, Valeri S, Coppola R, Verzì A, Tonini G |title=Large abdominal mass in Crohn's disease |journal=Gut |volume=53 |issue=10 |pages=1493, 1503 |date=October 2004 |pmid=15361501 |pmc=1774217 |doi=10.1136/gut.2003.035956 |url=}}</ref><ref name="pmid29258579">{{cite journal |vauthors=Yeika EV, Efie DT, Tolefac PN, Fomengia JN |title=Giant ovarian cyst masquerading as a massive ascites: a case report |journal=BMC Res Notes |volume=10 |issue=1 |pages=749 |date=December 2017 |pmid=29258579 |pmc=5735515 |doi=10.1186/s13104-017-3093-8 |url=}}</ref><br> | ||
❑[[Gastrointestine|GI]]<br> | ❑[[Gastrointestine|GI]]<br> | ||
:❑[[Volvulus]]<br> | :❑[[Volvulus]]<br> | ||
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:❑[[Leiomyoma]]<br> | :❑[[Leiomyoma]]<br> | ||
:❑[[Ureteropelvic junction obstruction]]/ urinomas<br> | :❑[[Ureteropelvic junction obstruction]]/ urinomas<br> | ||
:❑[[Testicular cancer]]|D05=<div style="float: left; text-align: left; length 14em; width: 14em; padding:1em;">'''[[Retroperitoneal]] mass'''<ref name="pmid14565853">{{cite journal |vauthors=Schrader AJ, Anderer G, von Knobloch R, Heidenreich A, Hofmann R |title=Giant hydronephrosis mimicking progressive malignancy |journal=BMC Urol |volume=3 |issue= |pages=4 |date=October 2003 |pmid=14565853 |doi=10.1186/1471-2490-3-4 |url=}}</ref><ref name="pmid30568516">{{cite journal |vauthors=Ojha U, Ojha V |title=Renal cell carcinoma presenting as nonspecific gastrointestinal symptoms: a case report |journal=Int Med Case Rep J |volume=11 |issue= |pages=345–348 |date=2018 |pmid=30568516 |doi=10.2147/IMCRJ.S178816 |url=}}</ref><ref name="pmid30559557">{{cite journal |vauthors=Mota MMDS, Bezerra ROF, Garcia MRT |title=Practical approach to primary retroperitoneal masses in adults |journal=Radiol Bras |volume=51 |issue=6 |pages=391–400 |date=2018 |pmid=30559557 |pmc=6290739 |doi=10.1590/0100-3984.2017.0179 |url=}}</ref><br>(majority tumors are [[malignant]])}} | :❑[[Testicular cancer]]|D05=<div style="float: left; text-align: left; width: 18em; padding:1em;">'''Pancreatic mass'''<ref name="pmid27065727">{{cite journal |vauthors=Karoumpalis I, Christodoulou DK |title=Cystic lesions of the pancreas |journal=Ann Gastroenterol |volume=29 |issue=2 |pages=155–61 |date=2016 |pmid=27065727 |pmc=4805734 |doi=10.20524/aog.2016.0007 |url=}}</ref><ref name="pmid21620466">{{cite journal |vauthors=Vincent A, Herman J, Schulick R, Hruban RH, Goggins M |title=Pancreatic cancer |journal=Lancet |volume=378 |issue=9791 |pages=607–20 |date=August 2011 |pmid=21620466 |pmc=3062508 |doi=10.1016/S0140-6736(10)62307-0 |url=}}</ref><br>❑[[Pancreatic cyst]]<br> | ||
{{familytree | | | | | | | | | | | | | | | | | | |!| }} | :❑[[Pancreatic cancer differential diagnosis|Neoplastic]] ([[Mucinous cystadenocarcinoma differential diagnosis|mucinous]], [[serous]], [[Intraductal papillary mucinous neoplasm|intraductal papillary]], and solid pseudopapillary)<br> | ||
{{familytree | :❑Non-neoplastic (true, [[mucinous]])<br> | ||
{{familytree | :❑[[inflammation|Inflammatory]] ([[Pancreatic pseudocyst|pseudocyst]], [[acute]] fluid collection)<br> | ||
❑Solid:<br> | |||
:❑[[Adenocarcinoma]]s ([[Pancreatic cancer classification|ductal]], [[bile duct]], [[Pancreatic cancer classification|ampullar]] and [[Small intestine cancer classification|duodenal]]) | |||
:❑[[Pancreatic neuroendocrine tumor]]s<br> | |||
:❑Others ([[lymphoma]] and [[metastasis]])| | |||
=<div style="float: left; text-align: left; length 14em; width: 14em; padding:1em;">'''[[Retroperitoneal]] mass'''<ref name="pmid14565853">{{cite journal |vauthors=Schrader AJ, Anderer G, von Knobloch R, Heidenreich A, Hofmann R |title=Giant hydronephrosis mimicking progressive malignancy |journal=BMC Urol |volume=3 |issue= |pages=4 |date=October 2003 |pmid=14565853 |doi=10.1186/1471-2490-3-4 |url=}}</ref><ref name="pmid30568516">{{cite journal |vauthors=Ojha U, Ojha V |title=Renal cell carcinoma presenting as nonspecific gastrointestinal symptoms: a case report |journal=Int Med Case Rep J |volume=11 |issue= |pages=345–348 |date=2018 |pmid=30568516 |doi=10.2147/IMCRJ.S178816 |url=}}</ref><ref name="pmid30559557">{{cite journal |vauthors=Mota MMDS, Bezerra ROF, Garcia MRT |title=Practical approach to primary retroperitoneal masses in adults |journal=Radiol Bras |volume=51 |issue=6 |pages=391–400 |date=2018 |pmid=30559557 |pmc=6290739 |doi=10.1590/0100-3984.2017.0179 |url=}}</ref><br>(majority tumors are [[malignant]])}} | |||
{{familytree | | | | | | | | |!| }} | |||
{{familytree | | | | | | | | |!| }} | |||
{{familytree | | | | | | | |,|^|-|.|}} | |||
{{familytree | | | | | | E01 | | E02 |E01=<div style="float: left; text-align: left; width: 14em; padding:1em;">'''Neoplastic'''<br> | |||
❑Solid<br> | ❑Solid<br> | ||
:❑[[Lymphoma]]<br> | :❑[[Lymphoma]]<br> | ||
Line 92: | Line 95: | ||
:❑[[Liposarcoma]]/ [[sarcoma]]<br> | :❑[[Liposarcoma]]/ [[sarcoma]]<br> | ||
:❑[[Renal cell carcinoma]]<br> | :❑[[Renal cell carcinoma]]<br> | ||
:❑[[Abdominal Aortic Aneurysm]] | :❑[[Abdominal Aortic Aneurysm]](AAA)<br> | ||
❑Cystic<br> | ❑Cystic<br> | ||
:❑Cystadenoma/ [[Mucinous cystadenocarcinoma|cystadenocarcinoma]]<br> | :❑Cystadenoma/ [[Mucinous cystadenocarcinoma|cystadenocarcinoma]]<br> |
Revision as of 18:47, 14 August 2020
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: , Javaria Anwer M.D.[2]
Synonyms and keywords: abdominal lump resident survival guide
Overview
An abdominal mass is a vast entity in oncology.
Causes
Life Threatening Causes
Life-threatening causes include conditions that may result in death or permanent disability within 24 hours if left untreated. The life-threatening causes of an abdominal mass include:
- Abdominal aortic aneurysm, specifically ruptured abdominal aortic aneurysm. Total mortality is estimated to be 80–90 %. The 2013 mortality rate of US population above 44 years of age was 2.5 per 100,000. The incidence is on the decrease for the past two decades after a plateau. (the mortality rates act as a surrogate of incidence).[1]
- Volvulus
Common Causes
Common causes of an abdominal mass described below follow a descending order. The list is based on a retrospective study from Turkey among 45 adult patients who underwent surgery because of an intra-abdominal mass (between May 2010 and May 2017).[2]
Benign pathologies
- Mesenteric cyst
- Endometriosis
- Hydatid cyst
- Fibroma
- Dystrophic calcification
- Aberrant pancreas
- Leiomyoma
- Pseudocyst
Malignant pathologies
- Gastrointestinal stromal tumor (GIST)
- Liposarcoma
- Ovarian tumor
- Chondrosarcoma
- Neuroendocrine tumor
- Malignt mesenchymal tumor
- Lymphoma
- Schwannoma
- The following chart illustrates the probable causes of an abdominal mass based on the location and salient features.
{{familytree | | |!| | | |!| |!| | | |!| | | |!| |}
Diagnosis
Shown below is an algorithm summarizing the diagnosis of abdominal mass according the the [...] guidelines.
Treatment
Shown below is an algorithm summarizing the treatment of abdominal mass according the the [...] guidelines.
Do's
- Start the assessment of a patient with an abdominal mass using the pneumonic "ABC:" airway, breathing and circulation, to identify an unstable patient.
- Taking careful history, and thorough physical examination are crucial to creating narrow differential diagnoses.
- Among females of childbearing age (average age 12 and 51 or start of menstrual cycle till menopause), pregnancy screening (usually a urine pregnancy test) should be performed before diagnostic radiation exposure or interventions such as fluoroscopy‐guided interventions.[15][16]
- Order an ultrasound or MRI among pregnant females to avoid exposure to radiation.
- Perform a pelvic and testicular examination among patients with lower abdominal pain.
- Correlate the CD4 count in HIV positive patients with the most commonly occurring pathology.
- Abdominal aortic aneurysm and malignancy are more important considerations among patients above 50 years of age than for younger patients.
- Suspect ruptured abdominal aortic aneurysm in old patients presenting with a pulsating mass, associated abdominal pain and a history of tobacco use.[17]
Don'ts
- The content in this section is in bullet points.
References
- ↑ Starnes, Benjamin (2017). Ruptured abdominal aortic aneurysm : the definitive manual. Cham: Springer. ISBN 978-3-319-23844-9.
- ↑ "cms.galenos.com.tr" (PDF).
- ↑ "ACS/ASE Medical Student Core Curriculum".
- ↑ Jo VY, Fletcher CD (February 2014). "WHO classification of soft tissue tumours: an update based on the 2013 (4th) edition". Pathology. 46 (2): 95–104. doi:10.1097/PAT.0000000000000050. PMID 24378391.
- ↑ Li M, Zhang L, Xu XJ, Shi Z, Zhao XM (November 2019). "CT and MRI features of tumors and tumor-like lesions in the abdominal wall". Quant Imaging Med Surg. 9 (11): 1820–1839. doi:10.21037/qims.2019.09.03. PMC 6902146 Check
|pmc=
value (help). PMID 31867236. - ↑ vom Dahl S, Mengel E (October 2010). "Lysosomal storage diseases as differential diagnosis of hepatosplenomegaly". Best Pract Res Clin Gastroenterol. 24 (5): 619–28. doi:10.1016/j.bpg.2010.09.001. PMID 20955964.
- ↑ Maharaj B, Cooppan RM, Maharaj RJ, Desai DK, Ranchod HA, Siddie-Ganie FM, Goqwana MB, Ganie AS, Gaffar MS, Leary WP (February 1986). "Causes of hepatomegaly at King Edward VIII Hospital, Durban. A prospective study of 240 black patients". S. Afr. Med. J. 69 (3): 183–4. PMID 3003936.
- ↑ Curovic Rotbain E, Lund Hansen D, Schaffalitzky de Muckadell O, Wibrand F, Meldgaard Lund A, Frederiksen H (2017). "Splenomegaly - Diagnostic validity, work-up, and underlying causes". PLoS ONE. 12 (11): e0186674. doi:10.1371/journal.pone.0186674. PMC 5685614. PMID 29135986.
- ↑ Maconi G, Manes G, Porro GB (February 2008). "Role of symptoms in diagnosis and outcome of gastric cancer". World J. Gastroenterol. 14 (8): 1149–55. doi:10.3748/wjg.14.1149. PMC 2690660. PMID 18300338.
- ↑ Sharma A, Naraynsingh V (January 2012). "Distended bladder presenting with constipation and venous obstruction: a case report". J Med Case Rep. 6: 34. doi:10.1186/1752-1947-6-34. PMC 3398309. PMID 22272565.
- ↑ Caricato M, Ausania F, Borzomati D, Valeri S, Coppola R, Verzì A, Tonini G (October 2004). "Large abdominal mass in Crohn's disease". Gut. 53 (10): 1493, 1503. doi:10.1136/gut.2003.035956. PMC 1774217. PMID 15361501.
- ↑ Yeika EV, Efie DT, Tolefac PN, Fomengia JN (December 2017). "Giant ovarian cyst masquerading as a massive ascites: a case report". BMC Res Notes. 10 (1): 749. doi:10.1186/s13104-017-3093-8. PMC 5735515. PMID 29258579.
- ↑ Karoumpalis I, Christodoulou DK (2016). "Cystic lesions of the pancreas". Ann Gastroenterol. 29 (2): 155–61. doi:10.20524/aog.2016.0007. PMC 4805734. PMID 27065727.
- ↑ Vincent A, Herman J, Schulick R, Hruban RH, Goggins M (August 2011). "Pancreatic cancer". Lancet. 378 (9791): 607–20. doi:10.1016/S0140-6736(10)62307-0. PMC 3062508. PMID 21620466.
- ↑ Abushouk AI, Sanei Taheri M, Pooransari P, Mirbaha S, Rouhipour A, Baratloo A (2017). "Pregnancy Screening before Diagnostic Radiography in Emergency Department; an Educational Review". Emerg (Tehran). 5 (1): e60. PMC 5585830. PMID 28894775.
- ↑ Gungor S, Celebi E (November 2019). "Detection of unrecognized pregnancy prior to a fluoroscopy-guided interventional procedure: A case report". Clin Case Rep. 7 (11): 2207–2211. doi:10.1002/ccr3.2437. PMC 6878093 Check
|pmc=
value (help). PMID 31788280. - ↑ "Diagnosis and management of 528 abdom... [Br Med J (Clin Res Ed). 1981] - PubMed - NCBI".