An abdominal mass is a localized swelling or enlargement in one area of the abdomen.
An abdominal mass is usually detected on routine physical examination. It may not have been detected by the affected person because most abdominal masses develop slowly.
An abdominal mass can be a sign of an abscess, a problem with a blood vessel (such as an aneurysm), an enlarged organ (such as the liver, spleen, or kidney), a tumor, or an accumulation of feces.
The abdomen is usually divided into 4 quadrants: right-upper quadrant, left-upper quadrant, right-lower quadrant, and left-lower quadrant. Other terms used to localize masses (or pain) in the abdomen include periumbilical, which describes the area around the navel, and epigastric, which describes the area in the center of the abdomen just below the ribcage. The location of the mass, and its firmness, texture, and other qualities can provide clues as to the cause of an abdominal mass.
- Abdominal aortic aneurysm can cause a pulsating mass around the navel.
- Bladder distention (urinary bladder over-filled with fluid) can cause a firm mass in the center of the lower abdomen above the pelvic bones, and in extreme cases can extend as far up as the navel.
- Cholecystitis can cause a very tender mass that is felt below the liver in the right-upper quadrant (occasionally).
- Colon cancer can cause a mass almost anywhere in the abdomen.
- Crohn’s Disease or bowel obstruction can cause multiple tender, sausage-shaped masses anywhere in the abdomen.
- Diverticulitis can cause a mass that is usually located in the left-lower quadrant.
- Gallbladder tumor can cause a moderately tender, irregularly shaped right-upper quadrant mass.
- Hydronephrosis (fluid-filled kidney) can cause a smooth, spongy-feeling mass in one or both sides or toward the back (flank area).
- kidney cancer can sometimes cause a mass in the abdomen.
- Liver Cancer can cause a firm, lumpy mass in the right upper quadrant.
- Liver enlargement (hepatomegaly) can cause a firm, irregular mass below the right rib cage (right costal margin), or on the left side in the stomach area (epigastric).
- Neuroblastoma, a malignant tumor often found in the lower abdomen, that primarily occurs in children and infants.
- Ovarian cyst can cause a smooth, rounded, rubbery mass above the pelvis in the lower abdomen.
- Pancreatic abscess can cause a mass in the upper abdomen in the epigastric area.
- Pancreatic pseudocyst can cause a lumpy mass in the upper abdomen in the epigastric area.
- Renal cell carcinoma can cause a smooth, firm, nontender mass near the kidney (usually only affects one kidney).
- Spleen enlargement (splenomegaly) - the edge of an Enlarged spleen may sometimes be felt in the left-upper quadrant.
- Stomach cancer can cause a mass in the left-upper abdomen in the stomach area (epigastric) if the cancer is large.
- Uterine leiomyoma (fibroids) can cause a round, lumpy mass above the pelvis in the lower abdomen (occasionally can be felt if the fibroids are large).
- Volvulus can cause a mass anywhere in the abdomen.
- Ureteropelvic junction obstruction can cause a mass in the lower abdomen.
All abdominal masses should be examined as soon as possible by the health care provider. In the meantime, a few measures can help reduce discomfort. Changing the body position can sometimes increase comfort if the mass is accompanied by discomfort.
If the mass is accompanied by sudden or severe pain, consider this an emergency situation, and see your health care provider immediately!
Call your health care provider if
- A pulsating abdominal mass exists, accompanied by severe Abdominal pain. This could be a ruptured aortic aneurysm, and is an emergency condition!
- You notice an abdominal mass of any sort. All masses should be examined by the health care provider (in fact, most abdominal masses are first noticed by the provider, not by the affected person).
What to expect at your health care provider’s office
In nonemergency situations, a complete medical history will be obtained and a physical examination performed. In emergency situations, the condition of the affected person will be stabilized first, then the abdomen will be examined and the medical history will be obtained.
Medical history questions documenting an abdominal mass in detail may include:
- Location o Is the mass in the upper abdomen? + Is the mass in the right-upper quadrant? + Is the mass in the left-upper quadrant? + Is the mass in the upper-middle area? o Is the mass in the lower abdomen? + Is the mass in the left-lower quadrant? + Is the mass in the right-lower quadrant? o Is the mass around the navel (periumbilical)? o Is the mass in the groin (inguinal)?
- Time pattern o How long ago was the mass noticed? o Does the lump or mass come and go? o How often have you seen the mass? (On how many occasions?)
- Other o Has the mass changed in size, position, extent of discomfort, or in any other way? o What other symptoms are also present?
The physical examination will include extra attention to the entire abdomen. Several position changes may be necessary during abdominal examination because some masses can only be felt in certain positions. A pelvic examination and a rectal examination may also be performed in some cases.
Diagnostic tests that may be performed are:
- Blood tests such as CBC and blood chemistry
- Abdominal X-ray
- Barium enema
- Abdominal CT scan
- Abdominal ultrasound
- Isotope study
- EGD - esophagogastroduodenoscopy
by Harutyun Medina, M.D.