Lumps and swellings

Congenital: Dermoid cyst, Haemangioma

Acquired:

- Traumatic
- Inflammatory
o Abscess, boils, carbuncles, cellulitis, lymphadenitis
- Neoplastic
o Lipoma, fibroma, papilloma, neurofibroma, lymphangiomas
- Other (degenerative, metabolic, parasitic, hormonal disorder)
o Sebaceous cysts, warts, condyloma

Short duration + Painful = Inflammatory

Long duration + Painful = Chronic inflammatory

Short duration + Painless = Malignant neoplasm

Long duration + Painless = Benign neoplasm

Pain  swelling = Inflammation

Swelling  Pain = Neoplasms (Except osteosarcoma)

Fever – Hodgkin’s disease, renal carcinoma

Progress of swelling

- Malignant neoplasm – Fast growth

- Benign lesions – Slow progress
- Inflammatory swelling – decrease in size when there is change in consistency / surface of
swelling

Multiple swellings

- Hodgkin’s disease, Neurofibromatosis

Impairment of function (Limb / spine)

- Caries spine  limit movement of spine

Recurrence of swelling

- After removal Indicates:

o Primary malignant growth
o Malignant changes in benign swelling
- Cystic swelling may recur if cyst wall is not completely removed
Loss of body weight

- Malignancy
- Cold abscess + Tuberculosis

Surrounding skin

- Red and edematous – Inflammatory swelling

- Tense, glossy, venous prominence – Sarcoma + rapid growth
- Black punctum over cutaneous swelling – sebaceous cyst
- Peau d’orange (orange peel) – breast carcinoma d/t blockage of small lymphatics draining
the skin

Colour

- Bluish: Ranula
- Red / purple: Hemangioma
- Black: Benign nevus / melanoma

“Expansile pulsation” – Swellings arising from arteries. Fingers are raised and separated.

“Transmitted pulsation” – Swellings superficial to arteries. Fingers only raised, not separated.

Movement with deglutition

- Thyroid swellings
- Thyroglossal cysts
- Pre / Para tracheal LN enlargement

Movement with protrusion of tongue

- Thyroglossal cyst

Benign tumours like lipoma – slip sign +ve (Slips away from palpating finger)

Consistency of a lump (Soft benign, hard cancer)

- Soft – Lipoma
- Firm – Fibroma
- Hard – Chondroma
- Bony hard – Osteoma
- Stony hard – Carcinoma
- Gaseous swelling with crepitus – gas gangrene, surgical emphysema
- Variable consistency – malignancy
- Fluctuant – Cystic (Exp: Hydrocoele)
Fluid thrill - +ve in fluid filled swelling

Impulse on coughing - +ve in Hernias, Meningocele

(Reducibility) Swelling disappears completely when pressed upon – Hernia

Auscultation:

- Bruits/ murmurs – Vascular lesions / Areas with abnormally increased BS (Enlarged thyroid)
- Bowel sounds – Inguinal hernia

Benign swellings Malignant swellings

- At younger age - Usually, >40yo
- Duration slow - Duration rapid
- No pain - Pain my occur in later stage
- No weight loss - Weight loss
- No loss of function - Loss of function

- Cachexia, anemia, weight loss absent - Cachexia, anemia, weight loss present

- Freely mobile - Fixed d/t infiltration

- Definite and regular border - Not well defined and irregular border

- Firm consistency - Hard/varying consistency

- Pressure effect absent - Pressure effect present

- J - Regional lymph nodes enlarged

- J - Distance metastasis present

- J - Secondary changes = common

- J - Often recurs after excision

- Well differentiated cells, encapsulated, - Undifferentiated cells, no capsules,

without anaplasia with anaplasia