The role of ultrasound in the differential diagnosis of palpable abdominal wall lesions
John Ferrier, Kate Kingston, Radiology, York Hospital, York
Background
Ultrasound is an important tool in assessing abdominal wall lesions. High frequency linear transducers allow detailed assessment of anatomy and high quality imaging of superficial pathology. The exact location of lesions with respect to the layers of the abdominal wall can be determined and dynamic Valsalva manoeuvre is particularly useful in the assessment of hernias.
Case report
We present a pictorial review encompassing the spectrum of palpable abdominal wall lesions encountered in our District General Hospital.
Abdominal wall masses can develop insidiously or acutely and as such present to primary care or a variety of secondary care specialties. Ultrasound is often the first line investigation and in many cases the only imaging modality undertaken. Rectus sheath haematoma often presents with pain, bruising and a rapidly-enlarging abdominal mass. While some patients have a predisposition such as bleeding disorders or anticoagulant medication, others occur spontaneously.
We will include the imaging findings of several abdominal wall haematomas seen in our department recently and outline the key anatomical landmarks. We present a pictorial review of the important alternative painful diagnoses including infection, abdominal wall hernias including postoperative appearances, endometriosis and fat necrosis. Other non-painful abdominal wall lesions such as lipomas, haemangiomas, pilomatrixomas and abdominal wall desmoids will also be depicted.
Discussion
Ultrasound is often the first line investigation for abdominal wall masses. Its role in characterising masses and determining whether further imaging is required is becoming increasingly useful. We present several cases of rectus sheath haematoma, outline the imaging and demonstrate the potential differential diagnoses as a pictorial review