...
Is the mass tender? A tender mass is most likely due to an infectious process such as mastitis or an abscess. However, chronic cystic mastitis may present with a tender mass. Also, advanced carcinoma of the breast usually produces a tender ... DIAGNOSTIC WORKUP
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... Smaller localized, freely movable masses are the sebaceous cysts, hematomas, lipomas, and lymph nodes. Masses that seem to be attached to the skull are osteomas, dermoid cysts, and sarcomas. Brain tumor tissue may occasionally protrude out beneath the scalp... DIAGNOSTIC WORKUP
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...
Is the discharge unilateral or bilateral? If it is unilateral and watery or bloody, one should look for a neoplasm in the breast. If it is bilateral and milky, one should look for the various conditions that cause ... DIAGNOSTIC WORKUP
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...
Is it tender? A tender vulval or vaginal mass would suggest vulvitis, hematoma, acute bartholinitis, or urethral caruncle.
Is it reducible? A reducible vulval or vaginal mass would suggest pudendal ... DIAGNOSTIC WORKUP
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...
Is it reducible? If the mass is reducible, it is most likely a femoral hernia or saphenous varix.
Is there an associated kyphotic curvature of the spine? The findings of a kyphotic curvature of the spine suggest a psoas abscess, ... DIAGNOSTIC WORKUP
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...
Is it painful? A painful rectal mass should suggest perirectal abscess, thrombosed hemorrhoid, anal ulcer, ruptured ectopic pregnancy, tubo-ovarian abscess, and pelvic appendix.
Is it soft or ... DIAGNOSTIC WORKUP
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...
The occurrence of a new palpable breast mass or a breast lesion on mammography is a common problem in clinical practice. Although breast lumps are a serious concern because of the risk of cancer, most breast lumps and other complaints are of benign origin. Multiple... Differential Diagnosis ... Workup and Diagnosis ... Treatment
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...
Breast pain (or mastalgia) is a common complaint that can often be diagnosed by a careful history and physical examination. Pain and tenderness may be normal during early pregnancy and before menses. Breast discharge, however, is rarely normal except in... Differential Diagnosis ... Workup and Diagnosis ... Treatment
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...
Any mass in the anal canal or rectum should be considered cancer until ruled out. Colorectal cancer must be considered, as it is the second leading cause of cancer death in the U.S., with greater than 40,000 mortalities each year. Early detection and aggressive... Differential Diagnosis ... Workup and Diagnosis ... Treatment
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...
Scrotal masses and swelling can involve the contents of the scrotum, the wall of the scrotum, and the scrotum itself. Ultrasonography should be used liberally in evaluating scrotal masses. All solid masses must be evaluated by surgical exploration. Torsion of the testis... Differential Diagnosis ... Workup and Diagnosis ... Treatment
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... Developing a differential of this condition can be done either histologically or with the mnemonic MINT. After all, once each structure or tissue is identified the significant lesions are either inflammatory or neoplastic. Let us apply the histologic
... READ EXCERPTS »
... Aside from the common external hemorrhoids (which will not be seen in many cases unless the patient is asked to bear down), anal masses may include any of the following:
Skin tag from previous ruptured or incised hemorrhoids
Sentinel piles
... READ EXCERPTS »
... It is not uncommon for a patient to complain of a lump on his or her back. Most of the time the lesion is a sebaceous cyst or lipoma. However, there are other types of back masses, and a simple method of recall is needed. Anatomy is the key. If
... READ EXCERPTS »
... A purulent discharge from the breast, just like a purulent discharge from any other body orifice, should signify inflammation (mastitis or breast abscess), yet this is not the most common cause of a nonbloody discharge from the breast. Obviously, the most common cause
... READ EXCERPTS »
... In developing the differential diagnosis of an epigastric mass, one merely needs to visualize the anatomy of the epigastrium from skin to spine. The conditions are presented in outline form in Table 5 , but the important conditions are emphasized in the following
... READ EXCERPTS »
... When the clinician tries to recall the causes of a mass in the extremities, he or she should consider the anatomy. As the clinician dissects downward from the skin, he or she encounters the subcutaneous tissue, veins, muscles, ligaments, bursae,
... READ EXCERPTS »
... More physicians have been fooled by a hypogastric mass than by a mass in any other area. How many times can you recall the mass disappearing on the operating table after catheterization of the bladder? More often than not, the mass is more apparent than real because of a lumbar
... READ EXCERPTS »
... Most of these lesions are tumors, but because some are caused by other etiologies, it is well to use the mnemonic MINT to review the possibilities.
M—Malformations include dermoid cysts, ranula, Wharton duct cysts or stones, mucous cysts, and
... READ EXCERPTS »
... Because most orbital masses cause exophthalmos, the differential diagnosis of the two is very similar (for illustration see section on exophthalmos, page 193). The best method to use to arrive at the causes is to visualize the anatomy of the orbit and
... READ EXCERPTS »
... Masses of the skin may be better termed nodules if they are larger than 0.5 cm and are not just neoplastic in origin. The term VINDICATE serves as a useful mnemonic to recall the important skin masses. When the physician is considering the cause of a mass in any part of
... READ EXCERPTS »
... When the clinician lays his or her hand on the right upper quadrant (RUQ) and feels a mass, he or she should visualize the anatomy and the differential diagnosis should become clear. Proceeding from the skin, the physician encounters the subcutaneous tissue, fascia, muscle, peritoneum,
... READ EXCERPTS »
... A localized mass on the head is usually a skin lesion, a lesion of the bone, or a protrusion of intracranial tissue through the bone. An extensive discussion of skin masses may be found on page 469, but most head masses originating from the skin are
... READ EXCERPTS »
... To quickly develop a list of etiologies of a left lower quadrant (LLQ) mass, visualize the anatomy of the area. Compared to the RUQ, the number of organs there is few. Beneath the skin, subcutaneous tissue, fascia, and muscle are the sigmoid colon, the iliac artery and
... READ EXCERPTS »
... The differential diagnosis for left upper quadrant (LUQ) masses is not a great deal different from that of the RUQ. The anatomy is similar: just replace the liver with the spleen and the gallbladder with the stomach. The presence of the aorta on the side of the abdomen should not be
... READ EXCERPTS »
... Although anatomy may assist somewhat in developing the differential here, it is probably an unnecessary exercise because the mnemonic MINT will bring to mind virtually all the etiologies.
M—Malformation reminds one of the broad nose of cretinism, Down syndrome,
... READ EXCERPTS »
... Nipple retraction, the inward displacement of the nipple below the level of surrounding breast tissue, may indicate an inflammatory breast lesion or cancer. It results from scar tissue formation within a lesion or large mammary duct. As the scar tissue shortens, it pulls... History and physical examination ... Medical causes ... Other causes ... Special considerations ... Pediatric pointers ... Pictures
... READ EXCERPTS »
... A commonly reported gynecologic sign, a breast nodule has two chief causes: benign breast disease and cancer. Benign breast disease, the leading cause of nodules, can stem from cyst formation in obstructed and dilated lactiferous ducts, hypertrophy or tumor... History and physical examination ... Medical causes ... Special considerations ... Pictures
... READ EXCERPTS »
... Anterior
Substernal thyroid
Thymoma
Lymphoma
Germinal cell neoplasm (e.g., dermoid)
Ascending aortic aneurysm
Parathyroid tumor
... READ EXCERPTS »
... Mastitis (parenchymatous inflammation of the mammary glands) and breast engorgement (congestion) are disorders that may affect lactating females. The prognosis for both disorders is good.
Causes and incidence
Mastitis develops when... Signs and symptoms ... Diagnosis ... Treatment ... Special considerations ... Pictures
... READ EXCERPTS »
... Nipple retraction, the inward displacement of the nipple below the level of surrounding breast tissue, may indicate an inflammatory breast lesion or cancer. It results from scar tissue formation within a lesion or large mammary duct. As the scar tissue... History and physical examination ... Medical causes ... Other causes ... Special considerations ... Pediatric pointers ... Patient counseling ... Pictures
... READ EXCERPTS »
... A commonly reported gynecologic sign, a breast nodule has two chief causes: benign breast disease and cancer. Benign breast disease, the leading cause of nodules, can stem from cyst formation in obstructed and dilated lactiferous ducts, hypertrophy or tumor formation in the ductal... History and physical examination ... Medical causes ... Special considerations ... Pediatric pointers ... Geriatric pointers ... Patient counseling ... Pictures
... READ EXCERPTS »
... Joyce A. Copeland
Approach The goal of the evaluation of a breast mass is to differentiate masses that are cancerous from benign masses in a timely and cost-effective manner.
History
A.... Physical examination ... Testing ... Diagnostic assessment
... READ EXCERPTS »
... Pepi Granat
Although most mediastinal masses are discovered incidentally on chest radiographs, symptoms can sometimes provide clues enabling the timely ordering of these films. The mediastinum is defined as the... Approach ... History ... Physical examination ... Testing ... Diagnostic assessment
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... Robert L. Hatch
Scrotal masses are common, occurring in all age groups, from infants to elderly men. In fact, up to 20% of adult males have varicocele (1). Many scrotal masses are benign and require no treatment, whereas others require immediate... Approach ... History ... Physical examination ... Testing ... Diagnostic assessment
... READ EXCERPTS »
... Differential Overview
Breast Mass
❑ Fibrocystic disease
❑ Fibroadenoma
❑ Breast cancer
❑ Intraductal papilloma ... Diagnostic Approach ... Clinical Findings ... Pictures
... READ EXCERPTS »
... Nipple retraction, the inward displacement of the nipple below the level of surrounding breast tissue, may indicate an inflammatory breast lesion or cancer. It results from scar tissue formation within a lesion or large mammary duct. As the scar tissue shortens, it pulls adjacent... History ... Physical assessment ... Medical causes ... Other causes ... Special considerations ... Pediatric pointers ... Patient counseling ... Pictures
... READ EXCERPTS »
... A commonly reported gynecologic sign, a breast nodule (also known as a breast lump) has two chief causes: benign breast disease and cancer. Benign breast disease, the leading cause of nodules, can stem from cyst formation in obstructed and... History ... Physical assessment ... Medical causes ... Special considerations ... Pediatric pointers ... Geriatric pointers ... Patient counseling ... Pictures
... READ EXCERPTS »
... Nipple retraction, the inward displacement of the nipple below the level of surrounding breast tissue, may indicate an inflammatory breast lesion or cancer. It results from scar tissue formation within a lesion or large mammary duct. As the... History and physical examination ... Medical causes ... Other causes ... Nursing considerations ... Patient teaching ... Pictures
... READ EXCERPTS »
... A commonly reported gynecologic sign, a breast nodule has two chief causes: benign breast disease and cancer. Benign breast disease, the leading cause of nodules, can stem from cyst formation in obstructed and dilated lactiferous ducts, hypertrophy... History and physical examination ... Medical causes ... Nursing considerations ... Patient teaching
... READ EXCERPTS »
...
Aside from the common external hemorrhoids (which will not be seen in
many cases unless the patient is asked to bear down), anal masses may
include any of the following:
Skin tag ... Pictures
... READ EXCERPTS »
...
It is not uncommon for a patient to complain of a lump on his or her
back. Most of the time, the lesion is a sebaceous cyst or lipoma. However,
there are other types of back masses, and a simple method of recall is
needed. ... Pictures
... READ EXCERPTS »
...
A purulent discharge from the breast, just like a purulent discharge
from any other body orifice, should signify inflammation (mastitis or breast
abscess), yet this is not the most common cause of a nonbloody discharge
from the breast. Obviously, the most common... Pictures
... READ EXCERPTS »
...
Developing a differential of this condition can be done either
histologically or with the mnemonic MINT. After all,
once each structure or
tissue is identified, the significant lesions are either inflammatory or ... Pictures
... READ EXCERPTS »
...
When the clinician tries to recall the causes of a mass in the
extremities, he or she should consider the anatomy. As the clinician
dissects downward from the skin, he or she encounters the subcutaneous
tissue, veins,... Pictures
... READ EXCERPTS »
...
To develop a list of possible causes of a face mass, let’s turn to
anatomy. The face is composed of skin, subcutaneous tissues, muscle, bone,
teeth, the sinuses, salivary glands, arteries, veins, and nerves. Applying the mnemonic VINDICATE to
each
... READ EXCERPTS »
...
Most of these lesions are tumors, but because some are caused by other
etiologies, it is well to use the mnemonic MINT to review the
possibilities.
M—Malformations include dermoid cysts, ranula, Wharton duct cysts
... READ EXCERPTS »
...
Because most orbital masses cause exophthalmos, the differential
diagnosis of the two is very similar (for illustration, see section on
exophthalmos, page 158). The best
method to use to arrive at the causes is to visualize the anatomy
of the orbit and then
... READ EXCERPTS »
...
Simply by thinking of the location of the pulsatile mass, one can
identify the cause or causes of a pulsatile mass.
Orbit. This is most likely an arteriovenous fistula related to
trauma or the spontaneous rupture of an aneurysm
... READ EXCERPTS »
...
Masses of the skin may be better termed nodules if they are larger than
0.5 cm and are not just neoplastic in origin. The term VINDICATE
serves as a useful mnemonic to recall the important skin masses. When the
physician is considering... Pictures
... READ EXCERPTS »
...
In developing the differential diagnosis of an epigastric mass, one
merely needs to visualize the anatomy of the epigastrium from skin to spine.
The conditions are presented in outline form in Table 5, but the
important conditions are emphasized in... Pictures
... READ EXCERPTS »
...
More physicians have been fooled by a hypogastric mass than by a mass
in any other area. How many times can you recall the mass disappearing on
the operating table after catheterization of the bladder? More often than
not, the mass is more... Pictures
... READ EXCERPTS »
...
The differential diagnosis of this symptom and sign is similar to that
of chest pain: Anatomy is the key to both. After visualizing all the
organs of the chest and cross-indexing them with the mnemonic MINT, a
convenient... Pictures
... READ EXCERPTS »
...
When the clinician lays his or her hand on the RUQ and feels a mass, he
or she should visualize the anatomy and the differential diagnosis should
become clear. Proceeding from the skin, the physician encounters the
subcutaneous tissue, fascia, muscle,... Pictures
... READ EXCERPTS »
...
A localized mass on the head is usually a skin lesion, a lesion of the
bone, or a protrusion of intracranial tissue through the bone. An extensive
discussion of skin masses may be found on page 396, but most head masses originating from the skin are ... Pictures
... READ EXCERPTS »
... Author:
Lindsey Albrecht, MD
What to Do - Gather Appropriate Data
The discovery of a breast mass in an adolescent female understandably awakens concern in both the patient and her family. Fortunately, the majority of ... Suggested Readings
... READ EXCERPTS »
... Author:
Renée Roberts, MD
What to Do - Make a Decision
The mediastinum is comprised of superior, anterior, middle, and posterior
compartments; however, masses in the anterosuperior compartment of children can be... Suggested Readings
... READ EXCERPTS »
... Charles Bailey, MD, PhDDon E. Eslin, MD, PhD (4th Edition) Mediastinal Mass - BASICS Mediastinal Mass - description Space-occupying lesion of the mediastinum: Anterior mediastinum ... Mediastinal Mass - DIAGNOSIS ... Mediastinal Mass - TREATMENT ... Mediastinal Mass - FOLLOW UP ... Mediastinal Mass - bibliography ... Mediastinal Mass - CODES ... Mediastinal Mass - FAQ
... READ EXCERPTS »
While a mammogram is one of the most important tests a woman can take, its findings often seem complex to many women. Learn what doctors look for...
Anthracyclines are becoming an increasingly important part of adjuvant therapy for breast cancer, with new data demonstrating its significant...
Anthracycline-based therapy is often recommended following surgery for breast cancer to reduce the risk of recurrence. This strategy has proved...
Certain breast cancers mean different things. Learn what tests can determine the type of breast cancer you have, and how this information can affect...
