Investigation of abdominal masses

Physical signs of abdominal masses

Physical signs of abdominal masses

Signs of hepatomegaly

  • Mass descending below right costal margin and costal angle
  • Moves with respiration and can not get above it
  • Dullness to percussion up to the level of the 8th rib in the mid-axillary line

Signs of splenomegaly

  • Mass descending below the left 10th rib and enlarging in a line towards the umbilicus
  • Often has a palpable notch on the medial border
  • Moves with respiration and can not get above it
  • Dullness to percussion
  • Can be brought forward by lifting the lower ribs
  • Can not be felt bimanually or balloted

Signs of a renal mass

  • Mass lies in paracolic gutter
  • Moves with respiration but usually only lower border is palpable
  • Can be felt bimanually or balloted
  • Not dull to percussion

Signs of an enlarged gallbladder

  • Mass arising from below the tip of the right 9th rib
  • Smooth and hemi-ovoid in shape
  • Moves with respiration
  • Dull to percussion
  • Can not feel space between mass and liver

Signs of an enlarged urinary bladder

  • Hemi-ovoid smooth mass arising from the pelvis
  • Can extend above umbilicus
  • Non-mobile and dull to percussion
  • Does not bulge into the pelvis
  • Can not be felt on rectal examination

Signs of an ovarian cyst

  • Smooth mass arising from the pelvis
  • Mobile from side-to-side but not up and down
  • Dull to percussion
  • Palpable fluid thrill
  • Lower extremity can be felt on pelvic examination

Causes of hepatomegaly

Smooth generalised enlargement

  • Congestion due to cardiac failure
  • Micronodular cirrhosis
  • Reticuloses
  • Hepatic vein obstruction (Budd-Chiari syndrome)
  • Infective hepatitis
  • Cholangitis
  • Portal pyaemia
  • Amyloidosis

Knobbly generalised enlargement

  • Secondary carcinoma
  • Macronodular cirrhosis
  • Polycystic disease

Localised swelling

  • Riedel's lobe
  • Hydatid cyst
  • Liver abscess
  • Hepatocellular carcinoma

Causes of splenomegaly


  • Bacterial - typhoid, typhus, TB
  • Viral - glandular fever
  • Protozoal - malaria, kala-azar

Cellular proliferation

  • Myeloid and lymphatic leukaemia
  • Pernicious anaemia
  • Polycythaemia rubra vera
  • Spherocytosis
  • Thrombocytopenia purpura
  • Myelosclerosis


  • Portal hypertension
  • Hepatic vein obstruction
  • Congestive heart failure


  • Amyloidosis
  • Gaucher's disease
  • Felty's syndrome
  • Angioma
  • Lymphosarcoma

Causes of a renal mass

  • Hydronephrosis
  • Pyonephrosis
  • Perinephric abscess
  • Hypernephroma
  • Nephroblastoma
  • Solitary cyst
  • Polycystic disease

Causes of a palpable gall bladder

  • Obstruction of the cystic duct
    • Stone in Hartmann's pouch
    • Cholangiocarcinoma
  • Obstruction of the common bile duct
    • Stone in common bile duct
    • Carcinoma of the head of the pancreas

Courvoisier's law

'If in the presence of jaundice the gallbladder is palpable, the obstruction of the bile duct causing the jaundice is unlikely to be due to a stone.'

Stones causes a thickened non-distensible gall bladder

Causes of a right iliac fossa mass

  • Appendicitis
  • Tuberculosis
  • Carcinoma of the caecum
  • Crohn's disease
  • Iliac lymphadenopathy
  • Psoas abscess



Last updated: 09 November 2010

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