Symptom Finder - Right Lower Quadrant Mass
Right Lower Quadrant Mass
Anatomy is once again the key to developing a differential diagnosis of a right lower quadrant (RLQ) mass. Underneath the skin, subcutaneous tissue, fascia, and muscle lie the cecum, appendix, terminal ileum, iliac artery and vein, and ileum. In the female, the fallopian tube and ovary
should be included. Occasionally a ptosed kidney also will be felt here. Now, apply the etiologic mnemonic MINT to each organ, and you should have a reliable differential diagnosis, like that in. The important lesions to remember here are the following:
M—Malformations such as inguinal and femoral hernias may be present.
I—Inflammations include acute appendicitis with abscess, tubo-ovarian abscesses, and regional ileitis.
N—Neoplasms to be considered in this area are carcinoma of the cecum and ovarian tumors.
T—Traumatic lesions include fracture or contusion of the ileum and perforation of the bowel from a stab wound.
The lymph nodes may be involved with tuberculosis or actinomycosis. The cecum may also be enlarged by accumulation of Ascaris or other parasites. The omentum can contribute to adhesions of the bowel to form a mass, or it may develop cysts.
Abdominal mass, left upper quadrant.
Approach to the Diagnosis
As with other abdominal masses, it is important to look for other symptoms and signs that will help determine the origin of the mass. If there are fever and chills, an appendiceal or diverticular abscess is possible. Blood in the stool suggests a diagnosis of colon carcinoma or intussusception. If there is amenorrhea or vaginal bleeding in a woman of childbearing age, an ectopic pregnancy must be considered. A long history of chronic diarrhea with or without blood in the stools suggests Crohn disease.
The initial workup will include a CBC, sedimentation rate, chemistry panel, stool for occult blood, pregnancy test, and flat plate of the abdomen.
If appendicitis is strongly suspected, ultrasonography should be performed without delay. If there is fever and an acute presentation, consultation with a general surgeon to consider an immediate exploratory laparotomy is indicated.
With a more insidious onset of the RLQ mass, the clinician has a choice of ordering a CT scan of the abdomen and pelvis after performing the initial diagnostic studies or proceeding systematically with a barium enema, IVP, or small-bowel series to determine the origin of the mass. A gastroenterology or gynecology consult may be the best way to resolve this dilemma.
Other Useful Tests
1. Sonogram (ectopic pregnancy)
2. Peritoneal tap (ruptured ectopic, peritoneal abscess)
3. Colonoscopy (colonic neoplasm)
4. Serum protein electrophoresis (plasmacytoma)
5. Indium scan (peritoneal abscess)
6. Aortogram (aortic aneurysm)
7. Lymphangiogram (retroperitoneal tumor)
8. Laparoscopy (neoplasm, ectopic pregnancy)
Abdominal mass, right lower quadrant.
Anatomy is once again the key to developing a differential diagnosis of a right lower quadrant (RLQ) mass. Underneath the skin, subcutaneous tissue, fascia, and muscle lie the cecum, appendix, terminal ileum, iliac artery and vein, and ileum. In the female, the fallopian tube and ovary
should be included. Occasionally a ptosed kidney also will be felt here. Now, apply the etiologic mnemonic MINT to each organ, and you should have a reliable differential diagnosis, like that in. The important lesions to remember here are the following:
M—Malformations such as inguinal and femoral hernias may be present.
I—Inflammations include acute appendicitis with abscess, tubo-ovarian abscesses, and regional ileitis.
N—Neoplasms to be considered in this area are carcinoma of the cecum and ovarian tumors.
T—Traumatic lesions include fracture or contusion of the ileum and perforation of the bowel from a stab wound.
The lymph nodes may be involved with tuberculosis or actinomycosis. The cecum may also be enlarged by accumulation of Ascaris or other parasites. The omentum can contribute to adhesions of the bowel to form a mass, or it may develop cysts.
Abdominal mass, left upper quadrant.
Approach to the Diagnosis
As with other abdominal masses, it is important to look for other symptoms and signs that will help determine the origin of the mass. If there are fever and chills, an appendiceal or diverticular abscess is possible. Blood in the stool suggests a diagnosis of colon carcinoma or intussusception. If there is amenorrhea or vaginal bleeding in a woman of childbearing age, an ectopic pregnancy must be considered. A long history of chronic diarrhea with or without blood in the stools suggests Crohn disease.
The initial workup will include a CBC, sedimentation rate, chemistry panel, stool for occult blood, pregnancy test, and flat plate of the abdomen.
If appendicitis is strongly suspected, ultrasonography should be performed without delay. If there is fever and an acute presentation, consultation with a general surgeon to consider an immediate exploratory laparotomy is indicated.
With a more insidious onset of the RLQ mass, the clinician has a choice of ordering a CT scan of the abdomen and pelvis after performing the initial diagnostic studies or proceeding systematically with a barium enema, IVP, or small-bowel series to determine the origin of the mass. A gastroenterology or gynecology consult may be the best way to resolve this dilemma.
Other Useful Tests
1. Sonogram (ectopic pregnancy)
2. Peritoneal tap (ruptured ectopic, peritoneal abscess)
3. Colonoscopy (colonic neoplasm)
4. Serum protein electrophoresis (plasmacytoma)
5. Indium scan (peritoneal abscess)
6. Aortogram (aortic aneurysm)
7. Lymphangiogram (retroperitoneal tumor)
8. Laparoscopy (neoplasm, ectopic pregnancy)
Abdominal mass, right lower quadrant.