EXAMINATION OF

THE SWELLING
GROUP FOUR
Definition
• A swelling denotes enlargement or
protuberance in any part of the body due to
congenital/ inflammatory/ traumatic or
neoplastic causes.
• We always use the word mass to mean a
swelling in the abdomen and lump a breast
swelling.
General Examination
• Assess for Jaundice, Parlour,cyanosis, finger
clubbing, lymphadenopathy, dehydration, vitals
like blood pressure, pulse rate, respiratory rate
and temperature, weight, nutritional status BMI
cachexia.
• Cachexia signifies for malignancy, increased
pulse rate and fever suggest swelling with
inflammatory pathology.
LOCAL EXAMINATION
• Inspection
• Palpation
• Percussion
• Auscultation
• Movement
INSPECTION
• Location: exact anatomical location of the
swelling
• Size:
• Shape: whether its globular or haemispherical,
oval, pear shaped, irregular, kidney shaped,
diffuse or well localised.
• Colour of the swelling: whether blue colour like
in haemangioma, black colour like in
melanoma, or redness which suggests
inflammation.
......
• surface over the swelling: smooth/ irregular/
nodular, cauliflower.
• Number of swellings multiple or single eg
neurofibromas or sebaceous cysts can be
multiple while dermatoid cysts are usually
single.
• Edge of the swelling whether well defined or I'll
defined.
• Pulsation over the swelling. A swelling which is
very close to an artery shows pulsation.
 Cont..
• Skin over the swelling; may be tense, glossy
with prominent veins as in sarcoma and
malignancy. Its red oedematous in
inflammatory swellings. Pigmentation,
ulceration, fungation and bleeding should be
inspected.
• Scar if present; its size, features whether
healed by primary or secondary intention.
PALPATION
• Its done propaly to define the swelling
anatomically and also find out the nature of the
content and its pathology.
• Local raise of temperature; this is checked
using back of the fingers which is very sensitive
than palmar aspect.its increased in
inflammatory conditions or tumors.
• Tenderness; its checked while palpating the
swelling by observing the face of the patient.
• Size is measured using a tape
Cont..
• Edge or margin; can be well defined in
superficial swellings, ill-defined in acts
conditions and deep swellings, irregular in
malignancy and regular in benign swellings.bits
examined using pulp of the index finger.
• Surface of the swelling; its done with Palmer
surface of the fingers. Maybe smooth, nodular,
lobular and irregular.
Cont...
• Consistency: it may be soft like lipoma, cysts,or
abscesses or hard like fibromad, neurofibromas,
chondromas etc
• Fluctuation;
• Reducibility;whether the swelling is reduced upon
pressing e.g in hernias
• Compressibility; swelling on pressure reduces in
size only but does not disappear completely and
on releasing the pressure the swelling comes back
to its original size and shape immediately. Eg
vascular and lymphatic swellings are compressible.
Cont......
• Pulsatility; two fingers are placed over the
swelling with adequate gap between two
fingers. If fingers over the swelling are raised
and separated with each beat of the artery, not
means pulsation is expansile eg in aneurysms.
If fingers are only raised but not separated,
then the pulsation of the swelling is said to be
transmitted eg in pseudocyst in the abdomen.
Cont....
• Fixity to the skin that's mobility of the skin over
the swelling.
• Fixity to the deeper structures; freely mobile
swellings could be in subcutaneous plane like
lipomas, hard and fixed shows its rising from
the bone.
PERCUSSION
• On percussion, the note maybe resonant like in
laryngoceal in the neck.
AUSCULTATION
• Its done to look for bruits over the swelling like
in arterial stenosis, anuerysms.
• Machinery murmur is heard non an aneurysmal
varix.
Movement
• Joints nearby swelling should be examined for
movenment to find out whether tye joint is
involved or not!