• Myriad of conditions manifest clinically with a palpable abdominal wall mass
• Key to diagnosis is careful history and physical exam
• Asymptomatic deep abdominal wall mass may be incidentally discovered on imaging studies
• Rectus hematomas may arise following abdominal wall trauma or occur spontaneously in patients receiving anticoagulant therapy
• Spontaneous abdominal wall metastases are most commonly associated with lung and pancreatic adenocarcinoma
• Any intra-abdominal malignancy can extend into the abdominal wall or secondarily seed laparotomy incisions
• Rectus hematoma: An exquisitely tender mass that becomes more painful with flexion of the abdominal wall with surrounding ecchymosis is the classic finding
• Deep wound infection or abdominal wall abscess: Signs of infection or inflammation (erythema, induration, tenderness, exudate)
• Abdominal wall hernia: A reducible bulge that develops with the Valsalva maneuver
• Soft-tissue neoplasms: Most are asymptomatic with a slow growth pattern
• Plain abdominal films are usually normal
• US can differentiate between a solid and a fluid-filled mass and reliably demonstrate the presence of abdominal viscera in the case of an incarcerated abdominal wall hernia
• CT will characterize the mass and differentiate between hematoma, fat, soft-tissue, and fluid-density lesions
• MRI is best method to evaluate soft-tissue masses suspicious for sarcoma
• Rectus hematoma
• Tumor metastasis
• Desmoid tumor
• Deep wound infection
• Abdominal wall abscess
• Soft-tissue sarcoma
• Incisional hernia
• Interparietal hernia
• Spigelian hernia
• Stitch abscess
• Stitch granuloma
• Tumor metastasis
• Soft-tissue sarcoma
• Careful history
-Constitutional symptoms (metastasis)
-Cesarean section (desmoid tumor, endometrioma)
-Familial adenomatous polyposis (desmoid tumor)
-Prior laparotomy (incisional hernia)
-Fever and chills (deep wound infection or abdominal wall abscess)
• Careful physical exam
-Mass reducible (hernia)
-Mass expanding (hematoma)
-Pain, erythema, and induration (deep wound infection or abdominal wall abscess)
• Obtain CT or MRI when solid mass is suspicious for abdominal wall metastasis, soft-tissue sarcoma, or desmoid tumor
• Perform percutaneous biopsy for solid mass
• Uncomplicated abdominal wall mass work-up may be performed as an outpatient
• Patients with deep wound infection or abdominal wall abscess need to be admitted for drainage and antibiotic therapy
• Patients with complicated hernia (incarcerated, strangulated, small bowel obstruction) require admission for urgent surgical treatment
• Rectus sheath hematoma: Correct coagulopathy, avoid antiplatelet medications, control pain, and provide expectant management
• Soft-tissue mass: Radiographic characterization with percutaneous or incisional biopsy to establish the diagnosis followed by definitive surgical excision
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