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Hard lump under the skin in the tibial area - Online Doctor Chats

Date : 21-Feb-2012
User rating for this question
Excellent Posted in: Bones, Muscles and Joints
Answered by

General & Family Physician
Practicing since : 2004
Answered : 36 Questions
User :   I have had a hard lump under the skin, just lateral to my tibia for several months. Suddenly it is larger, red and very painful to the touch. I will be seeing a dermatologist Friday, but wonder if it's something as simple as a carbuncle or as bad as a liposarcoma. It's red, warm and about i inch in diameter. No discharge, pus, or even an opening that would imply it needs to drain. Your thoughts?
Doctor :   Hi
Doctor :   I am Dr
Doctor :   How can I help you ?
User :   Hi there. By the way I paid twice in error, so more time?
User :   I have a large red and painful lump just under the skin as described above, what do you think?
Doctor :   You can get more time for that.
User :   Thank you
Doctor :   Ok, What is your age ?
User :   56
Doctor :   How are your blood sugar levels ?
User :   I'm diabetic and they have been high. I'm on injectible Victoza for that and weight loss
Doctor :   Ok.
Doctor :   It might be a simple boil (abcess) or carbuncle by the symptoms that you stated.
Doctor :   An abcess is warm, tender - pain on touch , reddish in color and due to inflammation.
Doctor :   How do you think is the consistency of the swelling - Soft, Hard, Fluid filled ?
User :   It is hard, painful and does not feel as if there is any fluid it in, just tissue.
Doctor :   Can you pinch the skin above it ?
User :   yes
Doctor :   That is a good sign.
Doctor :   How about its movement pertaining to underlying bone and deep tissues, is it movable above them are deeply stuck to deeper tissues ?
User :   It's right against the tibia so it feels bony of course and there isn't a lot of skin above it, but it can be squeezed. How is this determined to be one or the other, by sight by the M.D., or a biopsy, such as needle?
User :   I think deeply stuck, no easy to move, but it moves
Doctor :   So, it has to be examined by the Gen.Surgeon rather than a Dermatologist.
Doctor :   He will examine and by examination half of the diagnosis is done.
User :   Oh, okay. I will ask my doc for a referral but will also see him. Could this be life threatening?
Doctor :   If he feels he might advise for a Resection or Biopsy or FNAC.
User :   Can this be done in an office setting?
Doctor :   As far as I feel it must be a simple abcess and will be easily done by a general surgeon through I & D as a bed side procedure.
Doctor :   Incision & Drainage.
Doctor :   Do you have any systemic symptoms like fever ?
User :   That makes me feel a bit better, thank you. I have a family and personal history of lipomas, and being morbidly obese does not help matters.
User :   Oh, I should mention, I self prescribed Levaquin 500mg as of Sunday, for what I felt was a bladder infection. If this was an abscess wouldn't the Levaquin help it?
Doctor :   I understand, also taking into account your age and health status I would always narrow on to Abcess first and everything else next,
User :   So, I shouldn't lose too much sleep in the interim. Any suggestion for the pain?
User :   Hot compresses?
Doctor :   Sure hot compresses and Advil tab. thrice daily for 2 days.
User :   I take 600mg at a time (3 pills) okay?
Doctor :   Levaquin might help you out but for an antibiotic to show up in blood and start acting takes at least 3 days and more so in the abcess case, so it also needs a drainage and antibiotic dosage.
User :   so the fact there was a lump that was smaller and non-painful in that spot and suddenly it has grown in size, is hot, and painful is not necessarily anything to panic about?
Doctor :   Thrice daily is more helpful than taking it at once.
User :   I'm being silly,but worrying about cancer.
Doctor :   Yeah I strongly feel in two days once your Dermatologist sees you, You will be more happy and confident and will come back to say the good part of your story.
User :   That is very kind of you, thank you so much. I see him Friday afternoon. In the interim I will follow your advice of compresses and Advil. You have made me feel so much more confident and less frightened and I really appreciate it very much.
Doctor :   Thank you for consulting me & Take care , Get well soon.
Doctor :   Bye for now.
User :   Take Care, bye.
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