Ch 3 Pathology of Abdominal Wall/Chest

Question 1

List 4 abdominal wall pathologies?

Answer 1

Hematoma, abscess, hernias + neoplasms

Question 2

Where is the m/c superficial hematoma located?

Answer 2

Within the rectus sheath

(due to muscular trauma resulting in hemorrhage)

Question 3

List 3 post-traumatic causes of an abdo wall hematoma?

Answer 3

-Direct trauma (m/c)
-Surgery
-Exercise

Question 4

List 4 spontaneous causes of an abdo wall hematoma?

Answer 4

-Anticoagulant therapy
-Bleeding disorders
-Pregnancy
-Steroid therapy

Question 5

S/S of an abdo wall hematoma?

Answer 5

-Pain, maybe palpable mass
-M/c history of trauma
-Ecchymosis (discoloration) of abdominal wall
-Falling hematocrit value

Question 6

SF of an abdo wall hematoma?

Answer 6

Depends on age, changes with time

Acute: hypoechoic to anechoic
Older: variable depending on level of clotted blood

Question 7

Location of abdo wall hematomas?

Answer 7

Arcuate line

Question 8

What is an abdo wall abscess?

Answer 8

Fluid collection, due to post surgical infections or trauma

Question 9

S/S of an abdo wall abscess?

Answer 9

-Pain, maybe palpable lump
-Fever, increased WBCs
-Redness/warmth to area

Question 10

SF of an abdo wall abscess?

Answer 10

-M/c hypoechoic fluid filled mass with irregular borders
-Internal debris
-Possibly air (from gas producing bacteria)
-Enhancement

Question 11

Treatment for an abscess?

Answer 11

M/c antibiotics, can drain it too

Question 12

It is important to determine if an abdo wall abscess is intra-peritoneal or extra-peritoneal. How can we tell?

Answer 12

Look for the peritoneal line

Question 13

List 5 neoplasms of the abdo wall?

Answer 13

-Lipomas
-Desmoid tumors
-Endometrioma
-Soft tissue sarcomas
-Metastatic carcinoma

Question 14

What is a lipoma?

Answer 14

-Benign fatty tumor
-M/c benign mass of abdo wall

Question 15

What is the m/c benign mass of the abdo wall?

Answer 15

Lipoma

Question 16

SF of a lipoma?

Answer 16

-Echogenic or isoechoic
-Soft + compressible

Question 17

Treatment for a lipoma?

Answer 17

Surgery

Question 18

What is a desmoid tumor + where is it m/c found?

Answer 18

-Tumor composed of fibrous tissue
-M/c in the anterior abdo wall (arises from muscle, fascia or aponeuroses)

Question 19

Are desmoid tumors m/c benign or malignant?

Answer 19

Benign, but can become infiltrating + aggressive

Question 20

What is another name for desmoid tumors?

Answer 20

Aggressive fibromatosis

Question 21

What tumor is m/c in women due to it often being related to pregnancy?

Answer 21

Desmoid tumors

(is also related to previous abdo surgery)

Question 22

Treatment for desmoid tumors?

Answer 22

-Surveillance with multiple imaging modalities (due to possible malignant transformation)
-Possible spontaneous regression (decreased size)
-Surgery only if symptomatic (due to high recurrence rate after surgery)

Question 23

SF of desmoid tumors?

Answer 23

-Homogeneous
-Hypo/isoechoic
-Good through transmission
-May have CD flow (m/c seen in aggressive types)

Question 24

What are endometriomas of the abdo wall + where are they m/c found?

Answer 24

-Chocolate cysts along the abdo wall
-M/c found post operation (after c-sections or laparoscopies)

Question 25

Can endometriomas of the abdo wall occur in women who never had endometriosis?

Answer 25

Yes!

Question 26

What can endometriomas be mistaken for?

Answer 26

Incisional hernias

Question 27

Endometriomas can transform into ___?

Answer 27

Sarcomas

Question 28

S/S of endometriomas of abdo wall?

Answer 28

May be palpable + painful (may be associated with menstrual cycle)

Question 29

SF of endometriomas?

Answer 29

-Hypoechoic or complex
-Spiculated, infiltrates surrounding tissues
-Vascular
-Cystic, polycystic, mixed or solid mass

Question 30

What are sarcomas of abdo wall?

Answer 30

-Cancer of soft tissues
-Includes liposarcomas, rhabdomyosarcomas + fibrosarcomas

Question 31

Do sarcomas have a high or low incidence of recurrence?

Answer 31

High, post excision requires radiation therapy to lower chances of recurrence