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JAMA Surgery Clinical Challenge
July 2014

Abdominal Wall Mass

Author Affiliations
  • 1Department of Surgery, Providence Medical Center, Southfield, Michigan
JAMA Surg. 2014;149(7):743-744. doi:10.1001/jamasurg.2013.3403

A man in his 60s presented to the emergency department with a right flank mass that had been present for 4 weeks. The mass was associated with increasing pain as it grew rapidly, starting from the size of a dime and increasing to extend 15 cm. The patient reported spontaneous drainage of pus from the mass and an unexplained weight loss. His medical history included hypertension and diabetes mellitus; he had no recent travel. Physical examination revealed a large palpable mass with central fluctuance and surrounding erythema. The mass extended from the subcostal region to the anterior superior iliac spine on palpation and was tender to touch. No active drainage was noted; however, multiple pustules were present (Figure 1A). Computed tomography of the chest, abdomen, and pelvis showed a large (10 × 15 cm) soft-tissue mass in the right lateral abdominal wall, extending from the level of the diaphragm to the iliac crest (Figure 1B and C). The mass appeared to directly invade the liver and extend through intercostal spaces with multiple small areas of calcification. Core needle biopsy showed inconclusive results, and a recommendation was made for a fresh tissue biopsy. The patient was then taken to the operating room where an excisional biopsy was performed.

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