Differential Diagnosis of Abdominal Wall Masses
• Umbilical hernia : The hernia is through the umbilical scar. Those presenting at birth commonly resolve in the first years of life. • Tumor nodule of the umbilicus (secondary to intraperitoneal malignant neoplasm, also called Sister Mary Joseph nodule) • Supraumbilical elliptical swelling of attenuated linea alba (no cough impulse) • Spigelian hernia : A rare hernia found along the linea semilunaris at the lateral edge of the rectus sheath, most commonly a third of the way between the umbilicus and the pubis. • Sebaceous cyst • Rectus sheath hematoma (usually painful) • Paraumbilical: hernia The neck is just lateral to the umbilical scar. • Lipoma • Incisional hernia: It has an overlying scar. The sac may be very much larger than the neck of the hernia. • Epigastric hernia : It occurs in the midline between the xiphoid process and the umbilicus. They are usually small (<2 cm). They result when a knuckle of extraperitoneal fat extrudes through a small defect in the linea alba. Commonly irreducible and without an expansile cough impulse • Desmoid tumor (associated with Gardner’s syndrome)
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