Symptom Finder - Back Mass
BACK MASS
It is not uncommon for a patient to complain of a lump on his or her back. Most of the time, the lesion is a sebaceous cyst or lipoma. However, there are other types of back masses, and a simple method of recall is needed. Anatomy is the key. If the mnemonic MINT is applied to most of these structures, all of the important lesions can be recalled.
Skin
M—Malformations include pilonidal cysts and sebaceous cysts.
I—Inflammation suggests carbuncles and furuncles.
N—Neoplasms include hemangiomas, neurofibromas, lipomas, and metastatic tumors.
T—Trauma, of course, suggests contusions.
SUBCUTANEOUS TISSUE AND FASCIA
M—Malformations include hernias of Petit triangle.
I—Inflammation suggests lesions such as rheumatoid nodules and abscesses.
N—Neoplasms encompass those mentioned above.
T—Trauma includes contusions and lacerations. Anasarca may produce edema of the back.
MUSCLE
Muscle is frequently nodular in fibromyositis, and a bursa may occasionally swell significantly. Rupture of a muscle or ligament and contusions are traumatic lesions that may present a mass. Muscle spasm from back injuries is often significant enough to cause a “mass.”
BONE
Lesions of the bone are usually responsible for the deeper masses in the back.
M—Malformations include spina bifida, which may be occult or manifest as a swelling such as meningocele or meningomyelocele.
I—Inflammation suggests the gibbus of Pott disease (tuberculosis of thespine).
N—Neoplasm suggests metastatic neoplasm and multiple myeloma of the spine which may protrude from beneath the skin.
T—Trauma suggests the obvious mass of a fracture dislocation or hematoma of the periosteum of the spine.
RETROPERITONEAL STRUCTURE
Wilms tumors of the kidney and perinephric abscesses may present as a mass in the back.
Approach to the Diagnosis
With skin lesions, excision or biopsy is frequently the best approach. Masses of the deeper structures cannot be approached as aggressively until certain conditions have been ruled out by computed tomography (CT) scans and bone scans. If a meningocele or similar congenital lesion is suspected, a neurosurgeon must be consulted.
Other Useful Tests
1. X-ray of the thoracic or lumbosacral spine (malformations,
neoplasm)
2. Magnetic resonance imaging (MRI) of the thoracic or lumbar
spine (malformation, neoplasm)
3. Intravenous pyelogram (IVP) (Wilms tumor, perinephric abscess)
4. Tuberculin test
5. Serum protein electrophoresis (multiple myeloma)
6. Myelogram
7. Exploratory surgery
It is not uncommon for a patient to complain of a lump on his or her back. Most of the time, the lesion is a sebaceous cyst or lipoma. However, there are other types of back masses, and a simple method of recall is needed. Anatomy is the key. If the mnemonic MINT is applied to most of these structures, all of the important lesions can be recalled.
Skin
M—Malformations include pilonidal cysts and sebaceous cysts.
I—Inflammation suggests carbuncles and furuncles.
N—Neoplasms include hemangiomas, neurofibromas, lipomas, and metastatic tumors.
T—Trauma, of course, suggests contusions.
SUBCUTANEOUS TISSUE AND FASCIA
M—Malformations include hernias of Petit triangle.
I—Inflammation suggests lesions such as rheumatoid nodules and abscesses.
N—Neoplasms encompass those mentioned above.
T—Trauma includes contusions and lacerations. Anasarca may produce edema of the back.
MUSCLE
Muscle is frequently nodular in fibromyositis, and a bursa may occasionally swell significantly. Rupture of a muscle or ligament and contusions are traumatic lesions that may present a mass. Muscle spasm from back injuries is often significant enough to cause a “mass.”
BONE
Lesions of the bone are usually responsible for the deeper masses in the back.
M—Malformations include spina bifida, which may be occult or manifest as a swelling such as meningocele or meningomyelocele.
I—Inflammation suggests the gibbus of Pott disease (tuberculosis of thespine).
N—Neoplasm suggests metastatic neoplasm and multiple myeloma of the spine which may protrude from beneath the skin.
T—Trauma suggests the obvious mass of a fracture dislocation or hematoma of the periosteum of the spine.
RETROPERITONEAL STRUCTURE
Wilms tumors of the kidney and perinephric abscesses may present as a mass in the back.
Approach to the Diagnosis
With skin lesions, excision or biopsy is frequently the best approach. Masses of the deeper structures cannot be approached as aggressively until certain conditions have been ruled out by computed tomography (CT) scans and bone scans. If a meningocele or similar congenital lesion is suspected, a neurosurgeon must be consulted.
Other Useful Tests
1. X-ray of the thoracic or lumbosacral spine (malformations,
neoplasm)
2. Magnetic resonance imaging (MRI) of the thoracic or lumbar
spine (malformation, neoplasm)
3. Intravenous pyelogram (IVP) (Wilms tumor, perinephric abscess)
4. Tuberculin test
5. Serum protein electrophoresis (multiple myeloma)
6. Myelogram
7. Exploratory surgery
