epigastric mass

1. Lumbar mass

4. Anatomy of lumbar area
lumbar
colon
kidney
Adrenal
Retroperitoneum

9. Dullness in renal mass
Resonant normally and in case of splenic
or colonic masses

10. pathology

11. Colonic mass
• pericolic abscess
• carcinoma

12. Pericolic abscess
• complication of diverticulosis / IBD/amoebic
colitis
• pain , fever , leucocytosis, tender illdefined
fluctuant mass
• Hinchey classification
Stage I: pericolic or mesenteric abscess
Stage II: walled-off pelvic abscess
Stage III: generalized purulent peritonitis
Stage IV: generalized fecal peritonitis
• USG ,CT, MRI, barium enema is contraindicated
• IV antibiotics , USG/CT guided aspiration , colectomy

13. Ca colon
unexplained anemia is the common
presentation
Altered bowel habits , obstruction ,
perfotation, bleeding
 hard, nontender, fixed mass

15. Aetiology
1. DIET -Red meat, saturated fat and cholesterol
2.Alcohol and smoking
3.Radiation
4. Post-cholecystectomy and ileal resection and
ureterocolostomy status
5.Genetic causes
Familial Adenomatous polyposis coli.
Gardner's syndrome and Turcot’s syndrome.
Peutz jeger’s syndrome and Juvenile polyposis
syndrome.
HNPCC , Lynch syndrome1, Lynch syndrome 2
Aspirin and other NSAIDs, calcium are protective
against large bowel cancers

16. Types
1.Polypoidal
2.Ulcerative,
3.Annular,
4.proliferative
Investigations-stool for occult blood,
Barium meal follow through-irregular filling defect
Colonoscopy & Biopsy, CECT
Treatement - Right hemicolectomy, left hemicolectomy
chemotherapy (FOLFOX)

17. Retroperitoneal sarcoma
• liposarcoma is commonest sarcoma
• present as asymptomatic mass , obstruction
of bowel , ureter , vessels
• CECT , MRI
• wide local excision , multivisceral resection
• chemoradiation

19. Adrenal tumours
Adrenal cortical tumours
o Mostly benign (1%malignant)
o functioning or non-functioning tumours
o functioning tumours secrete sex hormones ,
mineralocorticoid , glucocorticoid
o non-functioning tumours commonly present as
incidentalomas
o Diagnosis by hormone assay, USG, CT
o adrenalectomy for benign adenomas
o Radical adrenalectomy+chemotherapy

20. Adrenal medullary tumours
neuroblastoma
• Commonest childhood tumour.
• It is a tumour of adrenal medulla.
• An aggressive malignant tumour in childhood
usually below the age of 5 years.
• asymptomatic mass , liver secondaries , orbital
secondaries , dancing eye syndrome ,
opsomyoclonus
• USG, CT, MRI, MIBG scan , urinary VMA
• adrenalectomy , debulking , chemotherapy

21. PHAEOCHROMOCYTOMA
• adrenal medullary tumour
• it is a norepinephrine secreting tumour
• benign or malignant
• headache , persistant or paroxysmal
hypertension , sympathetic overactivity
• may be associated with MEN-2 syndrome
• serum/ urinary
metanephrines/normetanephrines USG, CT, MRI,
MIBG scan
• surgical resection

22. Renal masses
• Cystic diseases of kidney
• hydronephrosis
• inflammatory mass
• Perinephric abscess
• renal tumours

23. Renal cysts
• simple cysts
• polycystic kidney disease
• medullary sponge kidney
• Multicystic kidney disease
• acquired cysts(hydatid cysts, dialysis)
• Asymptomatic, pain, hypertension , CRF
• aspiration , deroofing, marsupialisation,
hemodialysis, nephrectomy & transplantion

25. Hydronephrosis
• Due to obstruction of urine outflow
Hydronephrosis
Extramural
1.Aberrant renal vessels
2. carcinoma
3. Retroperitoneal fibrosis.
4. Retrocaval ureter
5.BPH
intramural
1.Congenital PUJ obstruction.
2. Ureterocele.
3. Neoplasm of ureter.
4. Narrow ureteric orifice.
5. Stricture ureter( stone,
pelvicsurgeries or tuberculosis )
Intraluminal
1.Stone
2. Sloughed papilla in papillary
necrosis
3.Phimosis

27. • Transient or persistant mass(dietl’s crisis) ,
renal failure
• IVU , USG , CT
• treatment according to the cause

28. Trauma
• Perirenal hematoma

29. Inflammatory
• Tuberculosis
• Pyonephrosis
• Perinephric abscess
• Renal Carbuncle
• USG , CT
• antibiotics , aspiration , drainage ,
nephrectomy

30. Neoplasms
Benign
• papillary adenomas
• medullary fibroma
• lipoma
Malignant
• Renal cell carcinoma
• wilms tumour

31. Wilms tumour
• common in first 4 years of life.
• arises from embryonic tissue containing epithelial
and connective tissue elements.
• bilateral in 5% cases.
• mass , fever, pain, hypertension , hematuria ,
congenital anomalies
• USG, CT, MRI,IVU
• nephroureterectomy + chemotherapy +
radiotherapy

32. Renal cell carcinoma
• Hypernephroma, Grawitz tumour
• It is an adenocarcinoma arising from renal
tubular cells
• More common in males; more common in 5th-
6th decade of life.

33. • von Hippel-Lindau disease , Birt-Hogg-Dube’
syndrome , tuberous sclerosis
• Diet high in animal fat
• asbestos, lead, cadmium
• Tobacco & Cigarette smoking
• long-term dialysis
• Analgesic nephropathy

34. • Mass , hematuria , clot colic ,varicocele,
secondaries , fever , polycythemia, stauffer
syndrome
• USG , CT , MRI ,IVU
• Radical nephrectomy / chemotherapy