Symptom Finder - Mass
Mass
With few exceptions, anatomy and histology are the basic sciences that are most useful in developing a differential diagnosis of a mass or swelling. It works as follows:
A 38-year-old white woman presents with a history of a right upper quadrant mass. Visualizing the anatomy in the right upper quadrant, we
see the gallbladder, colon, liver, duodenum, pancreas, and kidney.
By simply thinking of what is common, one can arrive at the following list of possibilities:
1. Gallbladder: carcinoma, hydrops
2. Colon: carcinoma
3. Liver: hepatoma, metastatic neoplasm, cirrhosis, hepatitis
4. Duodenum: A neoplasm of the ampulla of Vater would rarely
present as a right upper quadrant mass
5. Pancreas: pancreatic neoplasm, pseudocyst of the pancreas
6. Kidney: hypernephroma, hydronephrosis, or polycystic kidney
By visualizing the histology of each of these organs, one can broaden the list of possibilities. For example, the liver is made up of a capsule,
parenchyma, fibrous tissue, ducts, arteries, and veins. Considering the capsule, one would think of hematoma or subdiaphragmatic abscess;
considering the parenchyma brings to mind hepatoma; the fibrous tissue suggests alcoholic cirrhosis while the duct suggests biliary cirrhosis; the
veins would prompt consideration of hepatic vein thrombosis or pylephlebitis.
Applying the second step, as was done under the category of pain, one can develop a list of possibilities using a mnemonic. In this instance, it is
helpful to use the mnemonic MINT. Here is how that works:
M—Malformation suggests hepatic or renal cysts.
I—Inflammation or intoxication suggests hepatitis, alcoholic cirrhosis, pancreatitis with a pseudocyst, cholecystitis, subdiaphragmatic abscess,
liver abscess, perinephric abscess, or diverticular abscess.
N—Neoplasm suggests hematoma, metastatic neoplasm, cholangiocarcinoma, carcinoma of the pancreas, hypernephroma, or colon carcinoma.
T—Trauma would bring to mind laceration, contusion, or hematoma of any one of these organs.
Once again, by putting the anatomy and/or histology together with the
etiologic classification, one can develop a very useful table.
Now, the clinician has a list of possibilities that will help him or her ask the right questions in the interview with the patient. It will also help the
clinician to determine which tests to order in the workup.
With few exceptions, anatomy and histology are the basic sciences that are most useful in developing a differential diagnosis of a mass or swelling. It works as follows:
A 38-year-old white woman presents with a history of a right upper quadrant mass. Visualizing the anatomy in the right upper quadrant, we
see the gallbladder, colon, liver, duodenum, pancreas, and kidney.
By simply thinking of what is common, one can arrive at the following list of possibilities:
1. Gallbladder: carcinoma, hydrops
2. Colon: carcinoma
3. Liver: hepatoma, metastatic neoplasm, cirrhosis, hepatitis
4. Duodenum: A neoplasm of the ampulla of Vater would rarely
present as a right upper quadrant mass
5. Pancreas: pancreatic neoplasm, pseudocyst of the pancreas
6. Kidney: hypernephroma, hydronephrosis, or polycystic kidney
By visualizing the histology of each of these organs, one can broaden the list of possibilities. For example, the liver is made up of a capsule,
parenchyma, fibrous tissue, ducts, arteries, and veins. Considering the capsule, one would think of hematoma or subdiaphragmatic abscess;
considering the parenchyma brings to mind hepatoma; the fibrous tissue suggests alcoholic cirrhosis while the duct suggests biliary cirrhosis; the
veins would prompt consideration of hepatic vein thrombosis or pylephlebitis.
Applying the second step, as was done under the category of pain, one can develop a list of possibilities using a mnemonic. In this instance, it is
helpful to use the mnemonic MINT. Here is how that works:
M—Malformation suggests hepatic or renal cysts.
I—Inflammation or intoxication suggests hepatitis, alcoholic cirrhosis, pancreatitis with a pseudocyst, cholecystitis, subdiaphragmatic abscess,
liver abscess, perinephric abscess, or diverticular abscess.
N—Neoplasm suggests hematoma, metastatic neoplasm, cholangiocarcinoma, carcinoma of the pancreas, hypernephroma, or colon carcinoma.
T—Trauma would bring to mind laceration, contusion, or hematoma of any one of these organs.
Once again, by putting the anatomy and/or histology together with the
etiologic classification, one can develop a very useful table.
Now, the clinician has a list of possibilities that will help him or her ask the right questions in the interview with the patient. It will also help the
clinician to determine which tests to order in the workup.
