Introduction

The discovery of an intra-abdominal mass often poses significant diagnostic difficulties. The following case demonstrates this, and highlights some of the pitfalls.

	Case report

A 73-year-old man presented with a 2-year history of lower limb paraesthesiae, macrocytosis and a recent onset of left upper quadrant pain. Examination revealed a large, slightly tender, smooth mass arising from the left upper quadrant of the abdomen with the lower edge in the left iliac fossa. Laboratory investigation, including the assessment of catecholamine levels, was non-contributory.

	Questions

1	What investigations might help to determine the nature of the mass?
2	What is the probable diagnosis and what other imaging techniques might be useful?
3	What is the nature and presumed aetiology of these lesions?

	Answers

QUESTION 1
Grey-scale ultrasound examination is a useful primary investigation in determining the nature of discrete intra-abdominal masses, yielding information such as the size of the lesion and determining the mass to be solid or cystic. The structure from which the mass originates may be identified. In many cases ultrasound characteristics may be diagnostic.

In this case ultrasound was misleading, suggesting an enlarged spleen containing a partly sub-capsular/partly sub-splenic collection, . . . [Full text of this article]