17-Year-Old Female with Palpable Abdominal Mass Visible During Muscle Contraction

Case at a Glance

A 17-year-old female presents with a one-year history of a small, firm mass in the lower abdomen that becomes prominent only during abdominal muscle contraction. The patient has significant health anxiety affecting her quality of life.

Patient's Story

The patient noticed a dime-sized firm mass in her lower abdomen approximately one year ago. The mass is only palpable and visible when she actively contracts her abdominal muscles, becoming nearly imperceptible when muscles are relaxed. She describes the mass as hard and immovable when palpated during muscle contraction. The patient has a history of health anxiety and suspected obsessive-compulsive disorder, currently managed with CBD oil and nutritional supplements including B12 and vitamin D. She reports significant psychological distress related to catastrophic thinking about the mass, including fears of malignancy.

Initial Assessment

Physical examination revealed a small, firm, well-defined mass in the lower abdomen that becomes prominent during Valsalva maneuver or active abdominal muscle contraction. The mass appears to be located within or related to the abdominal wall musculature. Patient appears anxious but otherwise well. Vital signs stable.

The Diagnostic Journey

The patient had undergone extensive gastrointestinal workup the previous year for unrelated stomach issues, including upper abdominal ultrasound and gastroscopy, which were reportedly normal. Given the clinical presentation of a mass that becomes prominent with muscle contraction and the patient's age, differential diagnosis included abdominal wall hernias (particularly spigelian hernia), lipoma, fibroma, or muscle-related pathology such as rectus abdominis diastasis or muscle fiber herniation.

Final Diagnosis

Pending further evaluation with physical examination and targeted imaging. Clinical presentation most consistent with abdominal wall hernia or benign soft tissue mass within the abdominal wall musculature.

Treatment Plan

Scheduled for comprehensive physical examination including assessment during various muscle contractions and relaxation. Abdominal wall ultrasound or CT scan recommended for definitive characterization. Patient counseling regarding benign nature of likely diagnoses and referral for anxiety management support. Follow-up appointment scheduled within two weeks.

Outcome and Follow-up

Patient education provided regarding the likely benign nature of abdominal wall masses in young patients. Psychological support initiated for health anxiety management. Awaiting imaging results and definitive diagnosis to guide further management decisions.