Abdominal Mass Differential Diagnosis

The differential diagnosis for an abdominal mass can be organized into the following categories:

• Single Most Likely Diagnosis
  • Hepatomegaly: Enlargement of the liver can cause a palpable abdominal mass, often due to liver disease such as hepatitis, cirrhosis, or liver cancer. This is a common cause of abdominal masses, especially in patients with risk factors for liver disease.
• Other Likely Diagnoses
  • Nephromegaly: Enlargement of the kidneys can cause a palpable abdominal mass, often due to kidney disease such as hydronephrosis, pyelonephritis, or kidney cancer.
  • Splenomegaly: Enlargement of the spleen can cause a palpable abdominal mass, often due to splenic disease such as splenitis, splenic infarction, or lymphoma.
  • Ovarian cyst or tumor: Ovarian masses can cause abdominal swelling and can be benign or malignant.
  • Uterine fibroids: Benign tumors of the uterus can cause a palpable abdominal mass.
• Do Not Miss Diagnoses
  • Abdominal aortic aneurysm: A life-threatening condition that requires prompt diagnosis and treatment. An abdominal mass can be a sign of an aneurysm, especially in older patients with risk factors for vascular disease.
  • Appendicitis: Inflammation of the appendix can cause a palpable abdominal mass, often accompanied by pain, fever, and vomiting.
  • Intussusception: A condition where a part of the intestine telescopes into another part, causing bowel obstruction and potentially life-threatening complications.
  • Ectopic pregnancy: A pregnancy that develops outside the uterus can cause a palpable abdominal mass and is a medical emergency.
• Rare Diagnoses
  • Retroperitoneal fibrosis: A rare condition where fibrous tissue forms in the retroperitoneum, causing a palpable abdominal mass.
  • Castleman disease: A rare lymphoproliferative disorder that can cause a palpable abdominal mass.
  • Lymphangioma: A rare benign tumor of the lymphatic vessels that can cause a palpable abdominal mass.
  • Gastrointestinal stromal tumor (GIST): A rare tumor of the digestive tract that can cause a palpable abdominal mass.

Each diagnosis has a unique set of clinical features, laboratory findings, and imaging characteristics that can help guide the diagnostic process. A thorough history, physical examination, and diagnostic workup are essential to determine the underlying cause of an abdominal mass.