Lumbar mass
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Lumbar mass
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Anatomy of lumbar area
lum
bar
colon
kidney
Adrenal
Retroperitoneum
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Dullness in renal mass Resonant normally and in case of splenic
or colonic masses
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pathology
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Colonic mass
• pericolic abscess
• carcinoma
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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
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Ca colon
unexplained anemia is the common
presentation
Altered bowel habits , obstruction ,
perfotation, bleeding
hard, nontender, fixed mass
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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
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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)
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Retroperitoneal sarcoma
• liposarcoma is commonest sarcoma
• present as asymptomatic mass , obstruction of bowel , ureter , vessels
• CECT , MRI
• wide local excision , multivisceral resection
• chemoradiation
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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
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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
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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
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Renal masses
• Cystic diseases of kidney
• hydronephrosis
• inflammatory mass
• Perinephric abscess
• renal tumours
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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
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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
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• Transient or persistant mass(dietl’s crisis) , renal failure
• IVU , USG , CT
• treatment according to the cause
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Trauma
• Perirenal hematoma
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Inflammatory
• Tuberculosis
• Pyonephrosis
• Perinephric abscess
• Renal Carbuncle
• USG , CT
• antibiotics , aspiration , drainage , nephrectomy
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Neoplasms
Benign
• papillary adenomas
• medullary fibroma
• lipoma
Malignant
• Renal cell carcinoma
• wilms tumour
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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
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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.
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• 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
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• Mass , hematuria , clot colic ,varicocele, secondaries , fever , polycythemia, stauffersyndrome
• USG , CT , MRI ,IVU
• Radical nephrectomy / chemotherapy