RIGHT LUMBAR REGION LUMP CASE SHEET

Name

Age/Sex

Address

Socioeconomic status

Profession
Religion

Chief Complaint
Lump in the right central abdomen 3 months

History of present illness

Patient was apparently normal /maintaining normal health 3 months ago, when he
noticed a lump in the central abdomen to the right side of umbilicus.
When he first noticed, the size of the lump was around 5 x 5 cm.
The lump gradually increased in size and attained the present size of around 10 cm
There is also history of loss of weight (loss of appx.7-8 kg in 30 days) and loss of
appetite
No history of blood in urine / any difficulty in micturition
Lump is not associated with pain, fever
No history of trauma
No history of sudden increase in the size of the lump
No history of similar lump on opposite side of umbilicus or anywhere else in body.
No history of nausea, vomiting.
No history of recent onset of jaundice, abdominal distention, obstipation,
upper/lower GI bleed.
No history of alteration in bowel habits in terms of frequency and consistency.
No history of swelling of lower limbs
No history suggestive of TB
No history suggestive of metastasis.

Past History
No history of similar complaints in the past.
No co-morbid illness in the past
No surgical intervention in past

Personal History
Takes mixed diet
Bowel and bladder habits are normal.
Sleep and appetite are normal.
Non smoker and non alcoholic

Family history
No history of any cancer related death in the family.

Treatment History
Patient hasn`t underwent any type of treatment for the complaints.

Summary of History
A 46 yr old gentleman, without any co-morbid illness presented with a painless,
progressive lump in the right central part of abdomen for 3 months. Lump is
associated with history of loss of weight and loss of appetite. No history of blood in
urine / any difficulty in micturition. No history of any altered bowel symptoms. No
history of swelling of lower limbs. No history suggestive of TB. No history suggestive
of metastasis.

Physical Examination & General Survey

I have examined the patient with informed consent in a well lit room and adequate
exposure in the presence of family attendant.
Patient is conscious, coherent, co-operative
BMI -

Wt -

Hydration status Well maintained

Ht-

Performance scale
Pallor / Icterus / Cyanosis / Clubbing / Generalized lymphadenopathy / Pedal Edema

Vital signs
Pulse 78/min in the right radial artery , normal volume, regular rhythm, no radioradial delay and radio-femoral delay.
BP: 120/80 mmHg in right arm supine position.
A febrile
Respiratory rate : 14 cycles / min (abdomino-thoracic in male)

Examination of abdomen
Inspection

Abdomen is flat
Umbilicus is in midline and inverted
No engorged/dilated veins, abnormal arterial pulsations/ visible peristalsis
can be seen over abdomen
Fullness is present in the right lumbar and upper right iliac fossa regions.
Renal angles are normal
Hernial orifices including external genitalia appears normal
No supraclavicular fossa fullness is seen

Palpation

No local rise of temperature over abdomen

A non-tender intra abdominal, retro-peritoneal lump of size 10 x 7 cm in
vertical to horizontal direction is present and is occupying lower right lumbar
and upper right iliac fossa regions.
Lump is having smooth surface.
Except for the superior margin, rest all margins are well defined.
Superior margin of the swelling is not palpable as it is merging beneath the
coastal margins.
Fingers can be insinuated between the coastal margin and the lump.
Inferior border of swelling in 10 cm below the right coastal margin in midclavicular line, medial margin of the lump is palpable 3 cm lateral to midline
and lateral margin is 10 cm lateral to midline on right side.
This lump is firm in consistency, immobile, not moving with respiration.
Lump is non-ballotable and is bimanually not palpable.
Liver & Spleen are not palpable
No other abdominal lump was palpable

Palpation of renal angles, left supraclavicular regions normal

Hernial orifices and external genitalia normal

Percussion

Liver span is 14 cm
Lump is dull on percussion and is not continuous with liver dullness.
Rest of the abdomen is resonant.
No evidence of free fluid

Ausculation

Normal bowel sounds heard

Per rectal examination Normal

Systemic examination
Cardio vascular system, respiratory system and abdominal examination is
normal.
Summary of case

A 46 yr old gentleman, without any co-morbid illness presented with a

painless, progressive lump in the right central part of abdomen for 3 months.
On examination, a non-tender intra abdominal, retro-peritoneal lump of size
10 x 7 cm is occupying lower right lumbar and upper right iliac fossa regions.
Lump is having smooth surface. Except for the superior margin, rest all
margins are well defined. Fingers can be insinuated between the coastal
margin and the lump. This lump is firm in consistency, not moving with
respiration and immobile on manipulation. Lump is not crossing the midline,
non-ballotable and is bimanually not palpable. Lump is dull on percussion and
is not continuous with liver dullness. Rest of the abdominal and systemic
examination is normal.

Clinical Diagnosis (Provisional)

I would like to give a differential diagnosis. My 1st provisional diagnosis is a
Retroperitoneal tumor (malignant in origin) and 2nd diagnosis is Renal cell
carcinoma of right kidney.