Abdominal Masses

Authored by Dr Colin Tidy, 23 Jun 2014

Reviewed by:
Dr Helen Huins, 23 Jun 2014

Patient professional reference

Professional Reference articles are written by UK doctors and are based on research evidence, UK and European Guidelines. They are designed for health professionals to use. You may find the Bowel Cancer Screening (Colorectal Cancer) article more useful, or one of our other health articles.

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.[1]

  • 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).[3]
  • 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
  • Cholecystitis - very tender mass
  • Cholangiocarcinoma - moderately tender, irregularly shaped mass
  • Hepatomegaly
  • Liver cancer - firm, lumpy mass
Epigastric
  • Hepatomegaly - firm, irregular mass (also in right costal margin)
  • Pancreatic abscess or pseudocyst
  • Gastric carcinoma
Left upper quadrant
  • Splenomegaly
  • Gastric carcinoma
  • Pancreatic abscess or pseudocyst
  • Disorders of kidney and colon
  • Neurofibroma (rare)
Right flank
  • Hydronephrosis - smooth spongy mass
  • Renal cell carcinoma (smooth, firm, non-tender mass)
Periumbilical
  • Abdominal aortic aneurysm (pulsating mass)
  • Tumour somewhere in the gastrointestinal tract
Left flank
  • Hydronephrosis (smooth spongy mass)
  • Renal cell carcinoma (smooth, firm, non-tender mass)
Right iliac fossa
  • Actinomycosis
  • Amoebic abscess
  • Appendix mass or abscess
  • Caecal/colon cancer or distension
  • Crohn's disease (multiple tender, sausage-shaped masses)
  • Hernia
  • Ileocaecal mass caused by tuberculosis
  • Intussusception
  • Kidney abnormality
  • Ovarian tumour
  • Tumour in intra-abdominal testicle
Suprapubic
  • Distended bladder (firm mass can extend up to the umbilicus in extreme cases)
  • Neuroblastoma (in children and infants)
  • Uteropelvic junction obstruction
Left iliac fossa
  • Diverticulitis (abscess)
  • Hernia
  • Kidney abnormality
  • Ovarian tumour
  • Colorectal cancer
  • Tumour in intra-abdominal testicle
 Pelvis
(should not be able to palpate below mass)
  • Ovarian cyst - smooth, round, rubbery mass
  • Ovarian tumour
  • Pregnancy
  • Uterine fibroids (round, lumpy mass) or malignancy
 

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.
  • LFTs.
  • 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.

Further reading and references

  1. Referral for suspected cancer; NICE Clinical Guideline (2005)

  2. Abdominal Mass; Better Medicine Website

  3. Carnett's test; whonamedit.com

Hi guys, fairly new to this forum, here’s my story, about 5 months ago literally overnight I started to get abdominal pains cramp ect, it got to the point of feeling bloated waking up feeling sick...

matt38065
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