Abdomen 3
Description
The patient was an elderly man lying comfortably in bed. He
was above average height but appeared to have lost weight.
On examination of his head, there appeared to be loss of
weight with gaunt facies and hollowed out malar regions.
There was no abnormality noted on examination of his upper
limbs.
A quick inspection of the anterior aspect of his neck and
anterior aspect of his chest wall did not reveal any abnormality.
On examination of his abdomen, there was fullness in the
left lumbar region; no scars and the abdominal wall moved normally with
respiration, there was no visible peristalsis or pulsations. On palpation there
was a mass in the left lumbar region about 10 cms by 8 cms. The upper border
could be defined and it was possible to interpose one’s examining fingers
between the upper border and the costal margin (it was possible to get above the
lump). The edge of the lump was rounded, it was firm in consistency and it was
non-tender. It was felt on superficial palpation and was ballotable. The lump
did not move with respiration .The percussion note over it was resonant and
there was a systolic bruit audible over the mass.
There were no other lumps and no free fluid.
Analysis
♥
On general examination the impression is the patient has lost
weight. This has many causes (See ACES for PACES Page
291)
This impression is reinforced
on examination of the head.
ª
Fullness in the left lumbar region suggests enlargement of a
kidney (See ACES for PACES Page 301)
¨
The clinical features of the lump suggest that it is an enlarged
kidney (See ACES for PACES Page 314)
§
The fact that it is superficial and does not move with respiration
probably reflect the fact that it is very large and fixed to the surrounding
structures and this would suggest malignancy.
♥
Consider the causes of unilateral enlargement of a kidney
(See ACES for PACES Page 334). The presence of a bruit (suggesting
increased vascularity and thus a malignant tumour), the fact that it is fixed
(suggesting local invasion) and that the patient has lost weight would all point
to malignancy as the cause.
ª
Consider the causes of renal tumours
(See ACES for PACES Page 324)
¨
As the clinical features suggest malignancy the likely diagnosis
is:
Renal cell carcinoma
Diagnosis
§
Renal cell carcinoma
