Abdominal Wall Mass

DIFFERENTIAL DIAGNOSIS

Common

• Subcutaneous Lipoma
• Incisional Hernia
• Linea Alba Hernia
• Groin Hernia

Less Common

• Spigelian Hernia
• Lumbar Hernia
• Paraumbilical Hernia
• Umbilical Hernia
• Endometrioma
• Undescended Testis
• Enlarged Lymph Node
• Rectus Sheath/Subcutaneous Hematoma
• Fat Necrosis
• Desmoid Tumor
• Muscle Tear
• Divarication of Rectus Abdominis Muscle
• Umbilical Metastasis
• Abscess
• Granuloma
• Umbilical-Urachal Sinus

ESSENTIAL INFORMATION

Key Differential Diagnosis Issues

• Pay close attention to deep margin of any anterior abdominal wall mass because hernias may masquerade as abdominal wall masses

Defect may be small relative to size of mass and potentially overlooked

Hernia mass may be fixed and not reducible

May look like hypoechoic subcutaneous nodule or lipomatous mass

Check for continuity with deeper structures

– Also check for vascular configuration, peristalsis, and perform Valsalva maneuver

– Valsalva for groin hernia is better with patient standing upright, especially in those situations where supine examination negative and patient symptoms aggravated by weightbearing

If deep border of mass not seen, reassess with either CT or MR

Helpful Clues for Common Diagnoses

• Subcutaneous L ipoma

Often multiple and occur in middle age

Fusiform mass with thin, parallel, echogenic internal striations

– Compressibility similar to adjacent fat

Alternatively, well-defined, rounded or ovoid encapsulated echogenic mass without clearly definable linear fine striations
• Incisional H ernia

Can occur after any abdominal operation

– Presents months to years after surgery
• Linea A lba Hernia

Usually occurs in young to middle-aged patients

Typically occurs midway between xiphisternum and umbilicus

Protrusion of extraperitoneal fat through narrow defect in linea alba

– Occurs where vessels perforate fascia

Hernia though linea alba containing either echo-poor or echogenic fat in epigastric region

– Can be very small

– Often no change with Valsalva, as neck of linea alba hernia is tight

Fatty contents can strangulate and infarct
• Groin H ernia

Indirect inguinal hernia is 4x more common than direct inguinal hernia

– Direct inguinal hernia and femoral hernia have similar prevalence

Indirect hernia passes through deep inguinal ring, along inguinal canal, and out of superficial inguinal ring

– Neck located lateral to inferior epigastric vessels and above inguinal ligament

Direct hernia passes through floor of inguinal canal medially (transversalis fascia, Hesselbach triangle)

– Neck located medial to inferior epigastric vessels and above inguinal ligament

– Generally smaller than indirect inguinal hernias

Femoral hernia passes through femoral canal

– Neck located medial to femoral vein and below inguinal ligament, usually narrow

– More common in women

US can accurately identify presence, type, and content of groin hernia

– Content includes fat, omentum, fluid, and bowel

Helpful Clues for Less Common Diagnoses

• Spigelian H ernia

Defect in aponeurosis at lateral border of rectus abdominis muscle

– Between rectus abdominis medially and linea semilunaris laterally

Most commonly located in lower abdomen ~ 1/3 way between umbilicus and pubic crest

– Extends deep to external oblique aponeurosis

– In other words, does not extend into subcutaneous fat but remains within layers of abdominal wall

Prone to strangulation as neck narrow
• Lumbar H ernia

Through defect in posterolateral abdominal wall

Spontaneous, postsurgical, or posttraumatic

Herniation of retroperitoneal fat ± colon or small bowel
• Paraumbilical H ernia

In adults

Protrudes through side of umbilical ring

Extraperitoneal fat ± peritoneal contents
• Umbilical H ernia

In young children

1/3 of umbilical hernias close within 1 month of birth

Rarely persists beyond 3-4 years

Peritoneal content protrudes through patent umbilical ring

Large neck, therefore unlikely to strangulate
• Endometrioma

Palpable mass often near cesarean section scar or pelvic surgical scar

Pain ± cyclical pain occurring with menses

Solid, mainly hypoechoic, heterogeneous nodule

Infiltrating margins

Anechoic cystic areas infrequent

Peripheral hyperechoic ring

Mild internal vascularity

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Apr 9, 2020 | Posted by admin in MUSCULOSKELETAL IMAGING | Comments Off

DIFFERENTIAL DIAGNOSIS

Common

ESSENTIAL INFORMATION

Key Differential Diagnosis Issues

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Abdominal Wall Mass

Abdominal Wall Mass

Less Common

Helpful Clues for Common Diagnoses

Helpful Clues for Less Common Diagnoses

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Abdominal Wall Mass

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