William Herring, M.D.

© 2002

Recognizing
Abdominal Soft Tissue
Masses

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Soft Tissue Masses

 What to look for

 Bowel displacement
 Paucity of gas in an area of the abdomen or
pelvis normally containing bowel
 Pad sign
 Extrinsic impression on a loop of bowel
 Edge of a soft tissue mass
Find the Masses

Find the soft tissue masses in

this set of abdominal plain
films
Can you find the soft tissue mass?
The answer’s on the next slide.
 Splenomegaly
You can see the edge of the spleen projecting well below the
12th rib. The enlarged spleen displaces the stomach to the right.
Can you find the soft tissue mass?
The answer’s on the next slide.
 Calcifications

Myomatous Uterus
The huge uterus displaces bowel upwards out of the pelvis and
lower abdomen. The amorphous calcifications suggest fibroids.
 This is an 82 year-old male.
What do you think the “mass” represents?
 Hours
later

Bladder outlet obstruction-after catheterization, the dilated bladder

returns to normal size. The bowel gas returns to the pelvis.
Can you find the soft tissue mass?
The answer’s on the next slide.
There is an abnormal curvilinear density that forms the mass’s
inferior margin. This was a pancreatic pseudocyst.
Can you find the soft tissue mass?
The answer’s on the next slide.
This one is difficult to see. There is an abnormal curvilinear density
superimposed on the liver. This was a renal cyst (see CT).
Supine Decubitus view

Can you find the soft tissue mass

before you press the spacebar?
 There is a “pad sign” (extrinsic impression) on the loop of bowel in
the RLQ. This is caused by a soft tissue mass impressing the bowel
from outside. The CT shows an abscess from a ruptured appendix.
The patient was an unrestrained driver in an MVA.
Can you find the soft tissue mass?
The answer’s on the next slide.
 There is a soft tissue density above the urinary bladder in the
pelvis. This is the appearance of free fluid in the peritoneal cavity, a
consequence here of a ruptured spleen.
Important Points

 To find a soft tissue mass in the abdomen on

plain films, look for:
 Bowel displacement
 Paucity of gas in an area of the abdomen or
pelvis normally containing bowel
 Pad sign
 Extrinsic impression on a loop of bowel
 Edge of a soft tissue mass
Congratulations, You Graduate

You know
your soft
tissue
masses

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