Symptom Finder - Flank Mass
FLANK MASS
A flank mass is usually renal in origin. However, if the clinician immediately focuses on the kidney, he or she may be sadly mistaken because one forgets the other significant organs in the area. By realizing the anatomy of the area, the clinician will not be readily fooled. Starting with the abdominal wall, there may be a tumor, hematoma, or hernia. Penetrating deeper, one encounters the kidney and adrenal gland. Disorders of the kidney may be recalled by the mnemonic MINT.
M—Malformations include hydronephrosis, solitary cysts, and
polycystic kidneys.
I—Inflammation brings to mind a perinephric abscess and tuberculosis.
N—Neoplasms help to recall Wilms tumors and hypernephroma.
T—Trauma leads one to consider a hematoma or laceration of the kidney.
Looking at the adrenal gland, one need only recall the tumors of this gland such as a neuroblastoma, adrenocortical carcinoma, or pheochromocytoma. Surprisingly, other organs located near the flank may be palpated as a flank mass. In the right flank is an enlarged liver. As in the right upper quadrant, a carcinoma or collection of stool can be palpated in the flank. A pancreatic cyst or neoplasm may also present as mass. Moving into the retroperitoneal area, we again may find hematomas of the wall of the flank, bony tumors, and retroperitoneal sarcomas.
Approach to the Diagnosis
The history of trauma will be helpful in narrowing the diagnosis. If the mass is painful, it is more likely due to trauma or inflammation. If it is painless, a neoplasm or congenital malformation is more plausible.
Obviously, if there is fever a perinephric abscess, pyonephrosis, or tuberculosis is more likely. Turning to the laboratory, a CBC, urinalysis, urine culture and colony count, chemistry panel, and sedimentation rate should be ordered. X-ray diagnosis may be made with an IVP, but a more definitive diagnosis can be established with a CT scan of the abdomen or CT urography. It is wise to consult an urologist before ordering any x-ray procedure to help decide which is the most cost-effective approach.
Other Useful Tests
1. Sonogram (neoplasm, cyst)
2. VDRL test (aneurysm)
3. Renal angiogram (aneurysm, hemorrhage)
4. Cystoscopy and retrograde pyelography (hydronephrosis,
neoplasm)
5. Exploratory surgery
A flank mass is usually renal in origin. However, if the clinician immediately focuses on the kidney, he or she may be sadly mistaken because one forgets the other significant organs in the area. By realizing the anatomy of the area, the clinician will not be readily fooled. Starting with the abdominal wall, there may be a tumor, hematoma, or hernia. Penetrating deeper, one encounters the kidney and adrenal gland. Disorders of the kidney may be recalled by the mnemonic MINT.
M—Malformations include hydronephrosis, solitary cysts, and
polycystic kidneys.
I—Inflammation brings to mind a perinephric abscess and tuberculosis.
N—Neoplasms help to recall Wilms tumors and hypernephroma.
T—Trauma leads one to consider a hematoma or laceration of the kidney.
Looking at the adrenal gland, one need only recall the tumors of this gland such as a neuroblastoma, adrenocortical carcinoma, or pheochromocytoma. Surprisingly, other organs located near the flank may be palpated as a flank mass. In the right flank is an enlarged liver. As in the right upper quadrant, a carcinoma or collection of stool can be palpated in the flank. A pancreatic cyst or neoplasm may also present as mass. Moving into the retroperitoneal area, we again may find hematomas of the wall of the flank, bony tumors, and retroperitoneal sarcomas.
Approach to the Diagnosis
The history of trauma will be helpful in narrowing the diagnosis. If the mass is painful, it is more likely due to trauma or inflammation. If it is painless, a neoplasm or congenital malformation is more plausible.
Obviously, if there is fever a perinephric abscess, pyonephrosis, or tuberculosis is more likely. Turning to the laboratory, a CBC, urinalysis, urine culture and colony count, chemistry panel, and sedimentation rate should be ordered. X-ray diagnosis may be made with an IVP, but a more definitive diagnosis can be established with a CT scan of the abdomen or CT urography. It is wise to consult an urologist before ordering any x-ray procedure to help decide which is the most cost-effective approach.
Other Useful Tests
1. Sonogram (neoplasm, cyst)
2. VDRL test (aneurysm)
3. Renal angiogram (aneurysm, hemorrhage)
4. Cystoscopy and retrograde pyelography (hydronephrosis,
neoplasm)
5. Exploratory surgery
