Abdominal Mass in the Hypogastrium (Suprapubic Area)

CLINICAL DIAGNOSTIC MANUAL

An abdominal mass in the hypogastrium, or suprapubic area, is a clinical manifestation that can result from various pathologies. It is characterised by the presence of a palpable lump or swelling in the lower abdomen, above the pubic bone. Identifying and evaluating a mass in this area is crucial, as it may be related to the urinary, reproductive, or digestive systems, with causes ranging from benign conditions to malignancies.

Pathology	Symptoms and Clinical Signs	Suspicion Diagnosis	Confirmatory Diagnosis
Interstitial Cystitis	Chronic pelvic pain, increased urinary urgency and frequency, pain during urination	Based on clinical history and recurrent symptoms of pelvic pain and urinary problems	Cystoscopy with hydrodistension and bladder biopsy to observe Hunner’s ulcers and inflammatory changes
Uterine Fibroid	Heavy menstrual bleeding, pelvic pain, pressure on the bladder	Clinical suspicion based on symptoms and finding of a pelvic mass on examination	Pelvic ultrasound or MRI showing uterine masses consistent with fibroids
Ectopic Pregnancy	Acute abdominal pain, vaginal bleeding, signs of shock in severe cases	Suspected in women of childbearing age with abdominal pain and positive pregnancy test	Transvaginal ultrasound showing absence of intrauterine pregnancy with adnexal mass and elevated hCG levels
Bladder Cancer	Haematuria, pelvic pain, changes in urinary habits	Based on symptoms and finding of mass or irregularities in the bladder	Cystoscopy with biopsy and transurethral resection of the bladder to confirm the presence of cancerous cells
Meckel’s Diverticulitis	Abdominal pain, gastrointestinal bleeding, signs of bowel obstruction	Suspected in patients with unexplained abdominal pain and bleeding	Technetium-99m scintigraphy to detect ectopic gastric tissue, confirmed by surgical resection
Pelvic Abscess	Fever, severe pelvic pain, signs of local inflammation	Suspected in patients with fever, leucocytosis, and localised pelvic pain	Pelvic CT or MRI showing a fluid collection with abscess characteristics, confirmed by drainage and culture
Ovarian Tumour	Abdominal pain, abdominal distension, urinary or gastrointestinal symptoms	Suspected based on physical examination and presence of a pelvic mass	Pelvic ultrasound, MRI, and eventually biopsy during surgery to confirm the nature of the tumour