When Physical Examination Signs Point to Sinister Causes

A 55-year-old male presented with mild abdominal discomfort. On physical examination, a right upper quadrant abdominal mass was palpable and an obstructed right varicocele was evident. Ultrasonography and computed tomography revealed a 15 cm right renal tumor with a 2 cm aortocaval lymph node. The patient underwent an uneventful laparoscopic transperitoneal radical nephrectomy and lymphadenectomy and was discharged after 2 days. No complications or recurrence were noted at 6 months follow-up. This report signifies the importance of physical examination and attention to cardinal clinical signs and also the feasibility of laparoscopy in large renal tumor in expert hands.