A 57-year-old woman with longstanding type 2 diabetes on basal-bolus insulin therapy for 15–20 years and with a distant history of gastric bypass surgery presented to her primary care physician’s (PCP’s) office with concern about a subcutaneous right-sided abdominal mass. She had first noticed the painless mass about 2 months prior and did not notice any growth afterward. She had no known injury in the area and had not had any surgical procedure in the area.
Physical examination demonstrated a firm mass the size of a golf ball with no overlying skin changes such as erythema, ulceration, or drainage. The PCP ordered a limited abdominal ultrasound to help further characterize the mass. The ultrasound imaging showed a 3.3 × 1.5 × 2.0–cm heterogeneous, hypoechoic structure with similar echogenicity to the adjacent subcutaneous fat (Figure 1). The radiologist noted that it was suggestive of a hernia, although the differential...
