4. HOPI
The patient was apparently alright 1 months back
when she incidentally noticed a painless lump of
approximate 15x10cm in left lumbar region, which
has rapidly progressed to its present size.
There is no change in size of the lump and has no
association with bladder or bowel movements.
There was no pain associated with the lump with
any changes in position, or movement of trunk or
extremities.
5. Negative history
Patient had no h/o abdominal pain or distension or of alternate
constipation or diarrhea with passage of black colour stools.
No c/o vomiting or of early satiety/ hematemesis.
No c/o hesitancy/urgency/frequency.
No c/o colicky pain in the flanks radiating to inner thigh or
passage of stone or blood clots or dark colour urine.
No c/o evening rise of temperature, or fever with chills
/sweating/itching or weight loss.
No paroxysm of sudden palpitation with diaphoresis
No c/o periodic pain or episodes of pain in abdomen radiating to
back.
No c/o pain in the back or per vaginal bleed.
No c/o cough with hemoptysis.
6. Past history
No past h/o PTB/BA/HTN/DM/COPD or any
other chronic medical or surgical illness.
No history of taking any medication for any
disorder .
7. Personal history
The patient is married has 3 children
Takes mixed diet
Bowel/bladder functions are normal
No history of tobacco addiction or other
significant addiction.
Low socioeconomic status
Family history- no h/o similar illness in family
8. Menstrual history
Patient has menarche at 16 years of age
Her menstrual cycle are regular in duration
and frequency, and no c/o dysmenorrhoea.
9. Physical examination
The patient was examined under adequate light with
proper privacy in presence of a chaperone and with
implied consent in supine and sitting position, and
was examined from front and back.
Patient is cooperative and is oriented time ,place and
person.
The patient is average in built
Wt -62kg ht -165cm BMI- 23.4
Karnofsky status-90
10. .
Afebrile-temp-97 F
P-80/min taken in right radial artery in supine position,
which was regular in rate and rhythm, normovolumic
and no radioradial or radiofemoral delay.
BP-118/78mmHg taken in supine position in left
brachial artery.
No signs of pallor/icterus/cyanosis/clubbing/or
lymphadenopathy.
11. Per abdominal examination
Inspection
The abdomen is exposed from xiphisternum to mid thigh.
The abdomen in neither distended nor scaphoid in shape.
Umbilicus is central in position and inverted, and fullness noted
in left lumbar region.
Renal angle fullness present on left side.
There are multiple hyper pigmented patches present on
abdomen s/o fungal infection.
All the abdominal quadrants move proportionately with
respiration.
No signs of any scars or dilated veins over the abdomen, with no
visible peristalsis or appreciable cough impulse .
External genitalia and all hernial orifices are normal.
12. Palpation
On palpation findings of inspection were confirmed.
On superficial palpation temperature of abdomen is normal.
Abdomen is soft ,no guarding tenderness or rigidity present.
On palpation a well defined lump of 20x10cm is present on left lumbar
area, extending into umbilical region, 5 cm lateral to midline which
bimanually palpable and non ballotable , hard in consistency, non
reniform in shape with irregular margins, which does not moves with
respiration.
Fingers can be insinuated below the costal margins, and getting over the
swelling was possible.
The mass becomes less appreciable on straight leg raising test.
Shift test negative.
There is no organomegaly or any other mass palpable , no cough impulse
over the hernial orifices.
No inguinal lymphadenopathy or Virchow’s node palpable.
No tenderness present at the renal angles.
13. percussion
On percussion-tympanic note present all over the
abdomen.
Colonic resonance present over the mass.
Dull note present on renal angle.
No shifting dullness present.
Shifting test for the lump was negative.
Bs + on auscultation/no bruit heard over the mass.
Per rectal : normal anal tone with soft fecal matter present.
PV-NAD
15. In summary
A 48y/f presented with a painless lump which is rapidly
increasing in size, with no significant complain.
On examination:
On inspection renal angle fullness present on left side.
On palpation a well defined lump of 20x10cm is present
on left lumbar and umbilical region, which is bimanually
palpable and non ballotable, hard in consistency, non
reniform in shape with irregular margins, which does not
moves with respiration. Colonic resonance present over
the mass and dull note present on renal angle.
16. My provisional diagnosis is
48y/f with left sided renal mass probably renal
cell carcinoma with no clinical signs of
metastasis.
