VECTOR PRINCIPLE IN THE DIFFERENTIAL DIAGNOSIS OF ABDOMINAL MASSES: THE LEFT UPPER QUADRANT

An attempt has been made to better define the anatomy of the left upper quadrant by means of sagittal section anatomy. An approach to abdominal masses by means of displacement by a vector rather than a classification in to retroperitoneal and intraperitoneal is demonstrated.

The lesions are classified: posterior, mid or anterior, and infra- and supramesocolic.

The posterior masses are of the suprarenal portion of the spleen, adrenal, renal and some extraperitoneal. These are usually well outlined on the roentgenogram because of abundant fat surrounding them and because they tend to alter the normal triangular space in a characteristic manner.

The mid abdominal lesions, such as mid line extraperitoneal and pancreatic masses, are less well seen because of lack of fat soft tissue intertace and because they do not displace the easily visualized normal structures seen on plain film roentgenograms. They do not displace the splenic or renal artery in the same manner that most posterior structures do. They may be differentiated by the position of the transverse colon and the duodeno-jejunal junction. The barium filled stomach and colon separate the anterior masses of the abdomen.

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