Examination of a swelling (lump)

Question 1

What are the stages of the examination of a swelling(lump)?

Answer 1

Look, Feel, move, special tests, regional lymph nodes

Question 2

What is involved in the look stage of the examination of a swelling?

Answer 2

• Location / position, measured from a landmark
• Contour (if visible by inspection): regular or irregular
• Colour of the overlying skin e.g. erythematous, pigmented
• Abnormalities in the overlying skin e.g. peau d’orange
• Abnormal vessels / telangiectasia

Question 3

What is involved in the feel stage of the examination of a swelling?

Answer 3

• Surface e.g. smooth, rough, irregular
• Shape
• Size: use a tape measure
• Tenderness
• Temperature – palpate with the back of your hand
• Cough impulse?
• Consistency (Soft, firm, hard, rubbery, uniform, varied, lobulated)
• Compressible?
• Fluctuant?
• Pulsatile (high blood flow) or expansile (aneurysmal)? Is there a palpable thrill?

Question 4

What is involved in the move stage of the examination of a swelling?

Answer 4

Skin tethering - attempt to pick up a fold of skin over the swelling and compare the degree of tethering with the other side

• Tethering to deeper structures - attempt to move the swelling in different planes relative to the surrounding tissues.
• Tethering to muscles and tendons - palpate the swelling whilst asking the patient to use the relevant muscle.

Question 5

What special tests can be done in the examination of a swelling?

Answer 5

Transillumination - if you suspect the mass is filled with clear fluid (e.g. a hydrocoele), you should attempt to shine a pen torch through it.

• Auscultation for bruits or bowel sounds