TOC  | D-Dx    

Abdominal Mass Differential Diagnosis                                                           REF: Outlines of Clinical Medicine

Epigastric  |  RUQ  |  LUQ  |  RLQ  |  LLQ  |  Retroperitoneal  |  Kidney-Associated  |  Bilat.Adrenal Mass  |  Peritoneal        
A. Epigastrium

1. Gastric Cancer

2. Gastric Ulcer (perforation and scarring)

3. Esophageal Carcinoma with direct spread

Epigastric  |  RUQ  |  LUQ  |  RLQ  |  LLQ  |  Retroperitoneal  |  Kidney-Associated  |  Bilat.Adrenal Mass  |  Peritoneal     
B. Right Upper Quadrant

1. Hepatoma

2. Hepatic Cyst

3. Tumor of the Gall Bladder / Periampullary Carcinoma

4. Primary Small Intestinal Tumor

Epigastric  |  RUQ  |  LUQ  |  RLQ  |  LLQ  |  Retroperitoneal  |  Kidney-Associated  |  Bilat.Adrenal Mass  |  Peritoneal         
C. Left Upper Quadrant

1. Splenosis

2. Pancreatic Carcinoma (spread)

Epigastric  |  RUQ  |  LUQ  |  RLQ  |  LLQ  |  Retroperitoneal  |  Kidney-Associated  |  Bilat.Adrenal Mass  |  Peritoneal     
D. Right Lower Quadrant

1. Appendicitis (perforation with scarring)

2. Colonic Polyps

3. Colon Carcinoma

4. Cecitis - usually secondary to Crohn's Disease

Epigastric  |  RUQ  |  LUQ  |  RLQ  |  LLQ  |  Retroperitoneal  |  Kidney-Associated  |  Bilat.Adrenal Mass  |  Peritoneal         
E. Left Lower Quadrant

1. Diverticulitis

2. Diverticulosis

3. Colon Carcinoma

Epigastric  |  RUQ  |  LUQ  |  RLQ  |  LLQ  |  Retroperitoneal  |  Kidney-Associated  |  Bilat.Adrenal Mass  |  Peritoneal         
F. Retroperitoneal

1. Primary Tumors of Retroperitoneum

a. Sarcomas

b. Neuroendocrine tumors - neurofibroma, ganglioneuroma, pheochromocytoma

c. Lymphomas

d. Diffuse retroperitoneal carcinomas (undifferentiated and metastatic)

e. Chordomas

2. Retroperitoenal Fibrosis

a. Primary (idiopathic) - about 70% of cases

b. Secondary (listed below)

c. Drugs - methysergide, methyldopa, ergot alkyloids

d. Periarteritis - usually with aortic aneurysm

e. Malignant tumors

f. Radiation fibrosis

g. Infection - intrabdominal, gonorrhea, abscess

h. Lymphangitis

i. Retroperitoneal Hemorrhage (often after invasive proceedure)

j. Connective Tissue / Autoimmune Disease - systemic sclerosis, systemic lupus

k. Granulomatous Disease - tuberculosis, sarcoidosis

l. Biliary Tract Disease - including primary biliary cirrhosis, sclerosing cholangitis

Epigastric  |  RUQ  |  LUQ  |  RLQ  |  LLQ  |  Retroperitoneal  |  Kidney-Associated  |  Bilat.Adrenal Mass  |  Peritoneal         
G. Kidney Associated

1. Renal Carcinoma

2. Renal Cysts - including polycystic kidney disease

3. Adrenal Mass (see below)

4. Pheochromocytoma

5. Metastatic Disease

Epigastric  |  RUQ  |  LUQ  |  RLQ  |  LLQ  |  Retroperitoneal  |  Kidney-Associated  |  Bilat.Adrenal Mass  |  Peritoneal         
H. Bilateral Adrenal Mass

1. Metastatic Disease

a. Lung carcinoma

b. Breast carcinoma

c. Renal malignant tumor

d. Melanoma

e. Colon cancer (rare)

2. Primary Tumor

a. Lymphoma

b. Pheochromocytoma

c. Adrenocortical carcinoma

d. Neuroblastoma (pediatric)

3. Adrenal Hyperplasia (Endocrinopathy)

a. Corticotropin-dependent Cushing's Syndrome

b. Cushing's Disease (pituitary tumor)

c. Ectopic corticotropin section

d. Benign pheochromocytoma

4. Infectious Disease

a. Tuberculosis

b. Fungal - histoplasmosis, blastomycosis, coccidiomycosis, cryptococcosis

5. Miscellaneous

a. Incidental adrenal tumors

b. Myelolipoma

c. Hemorrhage

d. Amyloidosis

Epigastric  |  RUQ  |  LUQ  |  RLQ  |  LLQ  |  Retroperitoneal  |  Kidney-Associated  |  Bilat.Adrenal Mass  |  Peritoneal         
I. Peritoneal  

1. Abscess

2. Lymphoma

3. Peritoneal Carcinomatosis

4. Pelvic Neoplastm

Epigastric  |  RUQ  |  LUQ  |  RLQ  |  LLQ  |  Retroperitoneal  |  Kidney-Associated  |  Bilat.Adrenal Mass  |  Peritoneal         

       2007