Lumbar mass

Anatomy of lumbar area

lum

bar

colon

kidney

Adrenal

Retroperitoneum

Dullness in renal mass Resonant normally and in case of splenic

or colonic masses

pathology

Colonic mass

• pericolic abscess

• carcinoma

Pericolic abscess • complication of diverticulosis / IBD/amoebic

colitis

• pain , fever , leucocytosis, tender illdefinedfluctuant 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

Ca colon

unexplained anemia is the common

presentation

Altered bowel habits , obstruction ,

perfotation, bleeding

hard, nontender, fixed mass

Aetiology1. DIET -Red meat, saturated fat and cholesterol2.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

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 hemicolectomychemotherapy (FOLFOX)

Retroperitoneal sarcoma

• liposarcoma is commonest sarcoma

• present as asymptomatic mass , obstruction of bowel , ureter , vessels

• CECT , MRI

• wide local excision , multivisceral resection

• chemoradiation

Adrenal tumours

Adrenal cortical tumourso Mostly benign (1%malignant) o functioning or non-functioning tumourso functioning tumours secrete sex hormones ,

mineralocorticoid , glucocorticoid o non-functioning tumours commonly present as

incidentalomaso Diagnosis by hormone assay, USG, CTo adrenalectomy for benign adenomaso Radical adrenalectomy+chemotherapy

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

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

Renal masses

• Cystic diseases of kidney

• hydronephrosis

• inflammatory mass

• Perinephric abscess

• renal tumours

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

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 papillarynecrosis

3.Phimosis

• Transient or persistant mass(dietl’s crisis) , renal failure

• IVU , USG , CT

• treatment according to the cause

Trauma

• Perirenal hematoma

Inflammatory

• Tuberculosis

• Pyonephrosis

• Perinephric abscess

• Renal Carbuncle

• USG , CT

• antibiotics , aspiration , drainage , nephrectomy

Neoplasms

Benign

• papillary adenomas

• medullary fibroma

• lipoma

Malignant

• Renal cell carcinoma

• wilms tumour

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

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.

• 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

• Mass , hematuria , clot colic ,varicocele, secondaries , fever , polycythemia, stauffersyndrome

• USG , CT , MRI ,IVU

• Radical nephrectomy / chemotherapy