This section describes the common principles involved in the examination of a swelling.
The "sudden' finding of a lump by a patient does not necessarily imply that it has only recently developed. It is important to ask if any change in si/e or other characteristics have been noted since it was first detected and whether there are any associated features such as pain, tenderness or colour changes. The history of preceding events may also be of diagnostic help. Sometimes physical examination will reveal a lump of which the patient is unaware.
□ Inspect any mass carefully, noting change in the colour or texture of the overlying skin,
□ Gently palpate to elicit any tenderness or change in skin temperature.
□ Without causing undue tenderness (by palpation), define the site and shape of the mass. Measure its size and record the findings diagrammalically.
□ Keep the hand on the mass for a few moments to determine if it is pulsatile.
□ Assess the consistency, surface texture and margins of the mass.
□ Attempt to pick up a fold of skin over the swelling to assess skin fixation and contrast the mobility of the skin with the unaffected side.
□ Determine fixation to deeper structures by attempting to move the swelling in different planes relative to the surrounding tissues.
□ Look for fluctuation by compressing the swelling suddenly with one finger, using another finger to determine if a bulge is created.
□ Confirm the presence of lluctuation in two planes.
□ Auscultate for vascular bruits and other sounds.
□ Elicit transillumination in the dark. Press the lighted end of an electric torch into one side of the swelling.
A cystic swelling will light up if the fluid is translucent, provided that the covering tissues are not too thick.
Was this article helpful?