The differential diagnosis related to the abdominal wall includes soft-tissue neoplasms of the skin, muscle, fat, bone, and vasculature. Additionally, hernias, congenital abnormalities, hematomas, and infections may present as abdominal wall masses. Differentiation of tissue components, such as blood products, fat, and vascularity, is important for narrowing the differential diagnosis and defining the relationship of the mass to tissue planes and structures is imperative in guiding management. US Abdomen Although no recent studies have evaluated the diagnostic accuracy of US specifically for abdominal wall masses, it is typically considered a first-line imaging modality [29,30,32]. This is due to the many advantages of US, such as capability of real-time imaging, Doppler evaluation of blood flow, and ability to assess for clinical features, such as tenderness. US can sometimes depict classic features of benign lesions, such as lipomas, desmoid tumors, vascular malformations, rectus sheath hematomas, infections, pseudoaneurysms, and endometriosis [30,32-34,36- 38]. However, in the setting of solid lesions, further workup and potentially tissue sampling is often needed. Although perhaps not widely used as a first-line imaging option, US can also confirm the presence of malignant masses, such as metastatic disease, sarcomas, and lymphomas. In a prospective study of 358 patients presenting with soft-tissue masses, US was performed as an initial imaging modality, yielding effective triage results with 100% specificity in referring indeterminate or potentially malignant masses on to more definitive imaging (MRI) and subsequent workup [31]. In patients with suspected abdominal wall endometriosis, which presents as a mass in many instances, US correctly detected disease in approximately 97% of cases in a retrospective series of 151 patients evaluated surgically [36].
Palpable Abdominal Mass Suspected Neoplasm. The differential diagnosis related to the abdominal wall includes soft-tissue neoplasms of the skin, muscle, fat, bone, and vasculature. Additionally, hernias, congenital abnormalities, hematomas, and infections may present as abdominal wall masses. Differentiation of tissue components, such as blood products, fat, and vascularity, is important for narrowing the differential diagnosis and defining the relationship of the mass to tissue planes and structures is imperative in guiding management. US Abdomen Although no recent studies have evaluated the diagnostic accuracy of US specifically for abdominal wall masses, it is typically considered a first-line imaging modality [29,30,32]. This is due to the many advantages of US, such as capability of real-time imaging, Doppler evaluation of blood flow, and ability to assess for clinical features, such as tenderness. US can sometimes depict classic features of benign lesions, such as lipomas, desmoid tumors, vascular malformations, rectus sheath hematomas, infections, pseudoaneurysms, and endometriosis [30,32-34,36- 38]. However, in the setting of solid lesions, further workup and potentially tissue sampling is often needed. Although perhaps not widely used as a first-line imaging option, US can also confirm the presence of malignant masses, such as metastatic disease, sarcomas, and lymphomas. In a prospective study of 358 patients presenting with soft-tissue masses, US was performed as an initial imaging modality, yielding effective triage results with 100% specificity in referring indeterminate or potentially malignant masses on to more definitive imaging (MRI) and subsequent workup [31]. In patients with suspected abdominal wall endometriosis, which presents as a mass in many instances, US correctly detected disease in approximately 97% of cases in a retrospective series of 151 patients evaluated surgically [36].