Abdominal mass

Several conditions can cause an abdominal mass:

Slipping rib syndrome

Slipping rib syndrome refers to pain in your lower chest or upper abdomen which may be present when your lower ribs move a little more than normal.

Your ribs are the bones in your chest that wrap around your upper body. They connect your breastbone to your spine.

Causes

This syndrome usually occurs in the 8th to 10th ribs (also known as false ribs) at the lower part of your rib cage. These ribs are not connected to the chest bone (sternum). Fibrous tissue (ligaments), connect these ribs to each other to help keep them stable. The relative weakness in the ligaments can allow the ribs to move a little more than normal and cause pain.

The condition can occur as a result of:

Injury to the chest while playing contact sports such as football, ice hockey, wrestling, and rugby
A fall or direct trauma to your chest
Rapid twisting, pushing, or lifting motions, such as throwing a baseball or swimming

When the ribs shift, they press on the surrounding muscles, nerves, and other tissues. This causes pain and inflammation in the area.

Slipping rib syndrome can occur at any age, but it is more common in middle-aged adults. Females may be more affected than males.

Symptoms

The condition usually occurs on one side. Rarely, it may occur on both sides. Symptoms include:

Severe pain in the lower chest or upper abdomen. The pain may come and go and get better with time.
A popping, clicking, or slipping sensation.
Pain when applying pressure to the affected area.
Coughing, laughing, lifting, twisting, and bending may make the pain worse.

Exams and Tests

The symptoms of slipping rib syndrome are similar to other medical conditions. This makes the condition difficult to diagnose.

Your health care provider will take your medical history and ask about your symptoms. You will be asked questions such as:

How did the pain start?
Was there an injury?
What makes your pain worse?
Does anything help relieve the pain?

Your provider will perform a physical exam. The hooking maneuver test may be done to confirm the diagnosis. In this test:

You will be asked to lie on your back.
Your provider will hook their fingers under the lower ribs and pull them outward.
Pain and a clicking sensation confirms the condition.

On the basis of your exam, an x-ray, ultrasound, MRI or blood tests may be done to check for other conditions.

Treatment

The pain usually goes away in few weeks.

Treatment focuses on relieving the pain. If the pain is mild, you can use ibuprofen (Advil, Motrin) or naproxen (Aleve, Naprosyn) for pain relief. You can buy these pain medicines at the store.

Talk with your provider before using these medicines if you have heart disease, high blood pressure, kidney disease, liver disease, or have had stomach ulcers or internal bleeding in the past.
Take the dose as advised by your provider. Do not take more than the amount recommended on the bottle or advised by your provider. Carefully read the warnings on the label before taking any medicine.

Your provider may also prescribe pain medicines to relieve pain.

You may be asked to:

Apply heat or ice at the site of pain. Wrap the ice in a cloth. Do not put ice directly on the skin.
Avoid activities that makes the pain worse, such as heavy lifting, twisting, pushing, and pulling.
Wear a chest binder to stabilize the ribs.
Consult a physical therapist.

For severe pain, your provider may give you a corticosteroid injection at the site of pain.

If the pain persists, surgery may be done to remove the cartilage and lower ribs, although it is not a commonly performed procedure.

Outlook (Prognosis)

The pain often goes away completely over time, although the pain may become chronic. Injections or surgery may be required in some cases.

Possible Complications

Complications may include:

Difficulty breathing.
A pneumothorax from an injury during an injection.

There are usually no long-term complications.

When to Contact a Medical Professional

You should contact your provider right away if you have:

An injury to your chest
Pain in your lower chest or upper abdomen
Difficulty breathing or shortness of breath
Pain during daily activities

Call 911 or the local emergency number if:

You have sudden crushing, squeezing, tightening, or pressure in your chest.
Pain spreads (radiates) to your jaw, left arm, or between your shoulder blades.
You have nausea, dizziness, sweating, a racing heart, or shortness of breath.

Alternative Names

Interchondral subluxation; Clicking rib syndrome; Slipping-rib-cartilage syndrome; Painful rib syndrome; Twelfth rib syndrome; Displaced ribs; Rib-tip syndrome; Rib subluxation; Chest pain-slipping rib

Images

References

Cupit GL, Dixit S, Chang CJ. Thorax and abdominal injuries. In: Madden CC, Putukian M, McCarty EC, Young CC, eds. Netter’s Sports Medicine. 3rd ed. Philadelphia, PA: Elsevier; 2023:chap 52.

Kolinski JM. Chest pain. In: Kliegman RM, Toth H, Bordini BJ, Basel D, eds. Nelson Pediatric Symptom-Based Diagnosis. 2nd ed. Philadelphia, PA: Elsevier; 2023:chap 8.

McMahon, LE. Slipping rib syndrome: a review of evaluation, diagnosis and treatment. Semin Pediatr Surg. 2018;27(3):183-188. PMID: 30078490 pubmed.ncbi.nlm.nih.gov/30078490/.

Waldmann SD. Slipping rib syndrome. In: Waldmann SD, ed. Atlas of Uncommon Pain Syndromes. 4th ed. Philadelphia, PA: Elsevier; 2020:chap 72.

Review Date 10/15/2023

Updated by: C. Benjamin Ma, MD, Professor, Chief, Sports Medicine and Shoulder Service, UCSF Department of Orthopaedic Surgery, San Francisco, CA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

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Abdominal mass

An abdominal mass is swelling in one part of the belly area (abdomen).

Considerations

An abdominal mass is often found during a routine physical exam. Most of the time, the mass develops slowly. You may not be able to feel the mass.

Locating the mass helps your health care provider make a diagnosis. For example, the abdomen can be divided into four areas:

Right-upper quadrant
Left-upper quadrant
Right-lower quadrant
Left-lower quadrant

Other terms used to describe the location of abdominal pain or masses include:

Epigastric — center of the abdomen just below the rib cage
Periumbilical — area around the belly button

The location of the mass and its firmness, texture, and other qualities can provide clues to its cause.

Causes

Several conditions can cause an abdominal mass:

Abdominal aortic aneurysm can cause a pulsating mass around the navel.
Bladder distention (urinary bladder over-filled with fluid) can cause a firm mass in the center of the lower abdomen above the pelvic bones. In extreme cases, it can reach as far up as the navel.
Cholecystitis can cause a very tender mass that is felt below the liver in the right-upper quadrant (occasionally).
Colon cancer can cause a mass almost anywhere in the abdomen.
Crohn disease or bowel obstruction can cause many tender, sausage-shaped masses anywhere in the abdomen.
Diverticulitis can cause a mass that is usually located in the left-lower quadrant.
Gallbladder tumor can cause a tender, irregularly shaped mass in the right-upper quadrant.
Hydronephrosis (fluid-filled kidney) can cause a smooth, spongy-feeling mass in one or both sides or toward the back (flank area).
Kidney cancer can sometimes cause a smooth, firm, but not tender mass in the abdomen.
Liver cancer can cause a firm, lumpy mass in the right upper quadrant.
Liver enlargement (hepatomegaly) can cause a firm, irregular mass below the right rib cage, or on the left side in the stomach area.
Neuroblastoma, a cancerous tumor often found in the lower abdomen can cause a mass (this cancer mainly occurs in children and infants).
Ovarian cyst can cause a smooth, rounded, rubbery mass above the pelvis in the lower abdomen.
Pancreatic abscess can cause a mass in the upper abdomen in the epigastric area.
Pancreatic pseudocyst can cause a lumpy mass in the upper abdomen in the epigastric area.
Spleen enlargement (splenomegaly) can sometimes be felt in the left-upper quadrant.
Stomach cancer can cause a mass in the left-upper abdomen in the stomach area (epigastric) if the cancer is large.
Uterine leiomyoma (fibroids) can cause a round, lumpy mass above the pelvis in the lower abdomen (sometimes can be felt if the fibroids are large).
Volvulus can cause a mass anywhere in the abdomen.
Ureteropelvic junction obstruction can cause a mass in the lower abdomen.

Home Care

All abdominal masses should be examined as soon as possible by the provider.

Changing your body position may help relieve pain due to an abdominal mass.

When to Contact a Medical Professional

Get medical help right away if you have a pulsating lump in your abdomen along with severe abdominal pain. This could be a sign of a ruptured aortic aneurysm, which is an emergency condition.

Contact your provider if you notice any type of abdominal mass.

What to Expect at Your Office Visit

In nonemergency situations, your provider will perform a physical exam and ask questions about your symptoms and medical history.

In an emergency situation, you will be stabilized first. Then, your provider will examine your abdomen and ask questions about your symptoms and medical history, such as:

Where is the mass located?
When did you notice the mass?
Does it come and go?
Has the mass changed in size or position? Has it become more or less painful?
What other symptoms do you have?

A pelvic or rectal exam may be needed in some cases. Tests that may be done to find the cause of an abdominal mass include:

Abdominal and pelvic CT scan
Abdominal and pelvic ultrasound
Angiography
Barium enema
Blood tests
Colonoscopy
Esophagogastroduodenoscopy (EGD)
Paracentesis
Sigmoidoscopy
Stool analysis
Urine tests
X-rays of the chest or abdomen

Alternative Names

Mass in the abdomen

Images

Anatomical landmarks adult – front view
Digestive system
Fibroid tumors
Aortic aneurysm

References

Ball JW, Dains JE, Flynn JA, Solomon BS, Stewart RW. Abdomen. In: Ball JW, Dains JE, Flynn JA, Solomon BS, Stewart RW, eds. Seidel’s Guide to Physical Examination. 10th ed. St Louis, MO: Elsevier; 2023:chap 18.

Landmann A, Bonds M, Postier R. Acute abdomen. In: Townsend CM Jr, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery. 21st ed. St Louis, MO: Elsevier; 2022:chap 46.

McQuaid KR. Approach to the patient with gastrointestinal disease. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine. 26th ed. Philadelphia, PA: Elsevier; 2020:chap 123.

Review Date 10/20/2022

Updated by: Linda J. Vorvick, MD, Clinical Professor, Department of Family Medicine, UW Medicine, School of Medicine, University of Washington, Seattle, WA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

Learn how to cite this page

Uncomfortable Feeling Under Right Rib Cage

Abdominal mass

Slipping rib syndrome

Causes

Symptoms

Exams and Tests

Treatment

Outlook (Prognosis)

Possible Complications

When to Contact a Medical Professional

Alternative Names

Images

References

Review Date 10/15/2023

Related MedlinePlus Health Topics

Abdominal mass

Considerations

Causes

Home Care

When to Contact a Medical Professional

What to Expect at Your Office Visit

Alternative Names

Images

References

Review Date 10/20/2022

Related MedlinePlus Health Topics

Dr Narelle Bleasel FACD

Abdominal mass

Slipping rib syndrome

Causes

Symptoms

Exams and Tests

Treatment

Outlook (Prognosis)

Possible Complications

When to Contact a Medical Professional

Alternative Names

Images

References

Review Date 10/15/2023

Related MedlinePlus Health Topics

Abdominal mass

Considerations

Causes

Home Care

When to Contact a Medical Professional

What to Expect at Your Office Visit

Alternative Names

Images

References

Review Date 10/20/2022

Related MedlinePlus Health Topics

Dr Narelle Bleasel FACD

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