Right Abdominal Mass: Causes and Diagnostic Steps - Gastroenterology and Hepatology

Q: Right Abdominal Mass: Causes and Diagnostic Steps

Hello： A 35-year-old female has a noticeable mass palpated to the right of the umbilicus. <br>The patient is relatively petite. <br>The mass is more prominent when standing or sitting and less noticeable when lying down. <br>An abdominal ultrasound can assess the liver, gallbladd

Palpation of a suspected mass in the right abdomen?

Hello, Doctor: I have a few questions to ask: 1.
If there is a noticeable hard lump on the right side of the abdomen (approximately four fingerbreadths to the right of the navel) when standing or sitting, but it is less noticeable when lying down, what could this lump typically be considered clinically in this location? 2.
If the patient is relatively thin (BMI around 17), could the palpable lump just be an internal organ? Which organs are usually found in this area? 3.
If the patient undergoes an ultrasound while lying down and no abnormalities are detected, does this mean that the palpable lump is likely just normal tissue? 4.
Generally, is it standard procedure to first perform an ultrasound, and if there are issues found, then arrange for further imaging studies like a CT scan? In other words, if the ultrasound shows no problems, will no additional tests be scheduled? Thank you, Doctor!

Yíhuò de rén, 30~39 year old female. Ask Date: 2020/09/24

Dr. Lin Minghui reply Gastroenterology and Hepatology

Hello: A 35-year-old female has a noticeable mass palpated to the right of the umbilicus.
The patient is relatively petite.
The mass is more prominent when standing or sitting and less noticeable when lying down.
An abdominal ultrasound can assess the liver, gallbladder, pancreas, spleen, and kidneys for any issues, as well as detect large intra-abdominal tumors.
If the mass is more pronounced in an upright position, a subcutaneous tumor is also a possibility, and a vascular ultrasound of the muscles can be performed.
A CT scan can be helpful for diagnosing tumors in certain abdominal locations.
Wishing you peace and health.
Sincerely, Dr.
Ming-Hui Lin, Attending Physician, Gastroenterology Department, Taoyuan Hospital, Ministry of Health and Welfare.

Reply Date: 2020/09/24

More Info

When evaluating a right abdominal mass, several factors must be considered, including the patient's physical condition, the characteristics of the mass, and the appropriate diagnostic steps. Here’s a detailed breakdown addressing your questions:
1. Nature of the Hard Mass: The presence of a palpable mass in the right abdomen, particularly when it is more prominent when standing or sitting, can suggest several possibilities. Common considerations include:
- Organ-related masses: This could be an enlarged liver, gallbladder, or kidney. In thin individuals, the outlines of these organs may be more easily felt.

- Muscle or fat-related masses: In some cases, a muscle strain or a benign lipoma (fatty tumor) may present as a hard mass.

- Hernias: A hernia, particularly an inguinal or femoral hernia, could also present as a palpable mass that is more noticeable in certain positions.

- Lymphadenopathy: Enlarged lymph nodes can also be felt as masses in the abdominal area.

2. Implications of a Low BMI: In a patient with a low Body Mass Index (BMI) of around 17, it is indeed possible that the palpable mass is an organ. In this region, the most likely candidates include:
- Liver: An enlarged liver (hepatomegaly) can be felt, especially in thin individuals.

- Kidney: The right kidney may also be palpable, particularly if it is enlarged or if there is a mass associated with it.

- Colon: The ascending colon can sometimes be felt, especially if there is fecal retention or other abnormalities.

3. Ultrasound Findings: If an ultrasound examination does not reveal any abnormalities, it can suggest that the mass is likely a normal anatomical structure or benign in nature. However, it is important to note that not all conditions may be visible on ultrasound. For instance, certain small tumors or lesions may not be detected, and further investigation may be warranted if symptoms persist or worsen.

4. Diagnostic Protocol: The typical approach to abdominal masses usually begins with an ultrasound. This is a non-invasive, cost-effective method that can provide valuable information about the organs and any potential masses. If the ultrasound indicates abnormalities, further imaging such as a CT scan or MRI may be ordered for a more detailed evaluation. Conversely, if the ultrasound is normal, additional tests may not be necessary unless clinical symptoms suggest otherwise.

In summary, the evaluation of a right abdominal mass involves a careful consideration of the mass's characteristics, the patient's overall health, and the appropriate use of imaging studies. If you have ongoing concerns or if the mass is associated with symptoms such as pain, changes in bowel habits, or weight loss, it is crucial to follow up with a healthcare provider for further assessment and management. Regular monitoring and appropriate diagnostic testing are essential to ensure any underlying conditions are identified and treated promptly.

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