Abdominal masses are usually detected on physical examination rather than presented by the patient. Any patient with an unexplained abdominal mass should be referred for urgent specialist assessment.
- Examine supraclavicular and inguinal nodes.
- Inspection - scars (especially around the umbilicus for laparoscopy scars), distension, prominent veins, local swelling, pulsation, visible peristalsis, skin lesions, asymmetrical movement at eye level. Exclude lesions of the abdominal wall: the patient raises their head (no good for the lateral abdomen); the patient does straight leg-raising (Carnett's method), 'blowing test' (Valsalva's test); the patient strains as if toileting (Kamath's test).
- Palpation - use warm hands, and examine the tender areas last. Light palpation, then deep. Check for guarding, rigidity and rebound tenderness. Determine for any mass: site, tenderness, size and shape, surface (irregular or smooth), edge (regular or irregular), consistency (soft or hard), mobility, whether pulsatile or ballotable.
Causes of Abdominal Mass by Location
|Right upper quadrant||Epigastric||Left upper quadrant|
|Right flank ||Periumbilical ||Left flank|
|Right iliac fossa ||Suprapubic ||Left iliac fossa |
(should not be able to palpate below mass)
Investigations will depend on the site and likely clinical diagnosis The following may be helpful:
- Early ultrasound or CT scan.
- Hollow organs may require the use of a contrast medium (eg, barium enema, gastrointestinal series, intravenous pyelogram).
- FBC with film, ESR, U&Es.
- CXR and abdominal X-ray.
- Ultrasound or CT-guided fine-needle biopsy.
- Mantoux test.
- Paracentesis with fluid examination if ascites is present.
- Laparoscopy or laparotomy may ultimately be necessary to achieve a diagnosis.