Approach to an Abdominal Mass

In attempting to diagnose and characterize an abdominal mass, the anatomical site of origin should be sought. Abdominal compartmentalization (as shown in Table 1) may help to localize a mass in one patient, but may be theoretical in another. Due to its large size, a mass may present as being intra-abdominal even though it may have originated in the retroperitoneum. It might be difficult to decide whether a mass is located in the abdomen or in the chest or whether it involves both compartments (such as in cases of neuroblastoma). Nephroblastoma and neuroblastoma are 'typical' retroperitoneal masses of childhood, and their renal or extrarenal origin may be readily recognizable, although an 'unusual case' may unpredictably present. As for a pelvic mass, it is useful to differentiate whether its origin is prerec-tal, rectal (i.e., stool) or retrorectal. A hepatic mass is usually recognizable as such and can mostly be differentiated from an anterior abdominal mass of another origin. The final imaging diagnosis or differential diagnosis will depend on the macroscopic tissue characterization of a mass (i.e., solid, cystic, mixed), its architecture and definition, whether it is solitary or multiple (possibly metastatic) and involving one specific or more than one organ system.

Table 1. Differential site of origin of an abdominal mass

Peritoneum versus retroperitoneum Abdomen versus thorax versus both Kidney versus extrarenal location Pelvis versus upper anterior abdomen Liver versus extrahepatic location

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