Should I be concerned about a lump under my right clavicle?
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Hello, I have a lump under the skin beneath my right clavicle near the sternum seems to be over the costoclavicular joint/disc area. Not visible to the naked eye when standing arms at sides very small lump barely palpable, found when retracting shoulder, becomes more prominent. About 1/2 inch round hard but not bone hard. Seems to get irritated with activities requiring heavy arm movement, non-tender otherwise. Able to put left arm behind me and touch area between shoulder blades (almost touching back of neck), right arm only able to reach bottom right scapula at best, no higher. Moderate pain mid back wraps around to chest cracking and popping at sternum and shoulders. Only happened upon bump, unsure how long it's been there back pain long standing after accident in 2002. Hx: 32 yo female - Mild thoracic ddd and scoliosis on X-ray (2013) - CT Scan 2013 for other issue showed mediastinum normal. - Car accident 11 years ago, pain mid back under shoulder blades, multiple MRI and X-ray with no abnormalities - Shingles bout 10/2013 small rash at right waistline just below last rib, treated with famvir. - 2 mm thyroid nodule on left euthyroid. - no breast lumps, cardiac labs and imaging, ekg normal as of 8/2013. No respiratory issues. - am a nurse positive ppd negative quantiferon and chest X-ray. Also at the time I noticed approximately 8/2013 I was exercising in the gym lifting weights etc. the ROM with my right arm has always been off since the accident. Also hav occasional tingling/numbness down inside of arm to pinky finger. Began taking turmeric burning wraparound sternal rib pain/inflammaton subsided subsided drastically within a month. Now just with pain between and under shoulder blades. Allergic to NSAIDs.
Posted Thu, 19 Dec 2013 in Abdominal Pain
Answered by Dr. T Shobha Deepak 58 minutes later
Brief Answer: Good clinical examination and ultrasound required Detailed Answer: Namaste Welcome to Healthcare-Magic Greetings of the day When the swelling is near costoclavicular joint it's unlikely to affect the shoulder movement. From your description I could suggest the possibility of 1. Dermoid Cyst 2. Tuberculoma ( because of ppd positive) 3. Lipoma or chronic inflammatory swelling The.correct diagnosis will depend on good clinical examination by an experienced surgeon and also collaborated by radiological investigation. Getting a ultrasound scan will be helpful as this will provide information about whether it's solid or fluid filled cystic lesion. Depending on that fine needle aspiration cytology can be planned. Sending clinical photograph showing the exact location may also.be helpful I hope I have answered your query Kindly get back to me if you have any other query Dr T Shobha MBBS MD
Follow-up: Should I be concerned about a lump under my right clavicle? 16 hours later
Thank you for your response, I will send a photo of the location and also have this checked. Since my initial question, after resting my arm after a heavy use day, the bump is no longer inflamed and returned to the size I originally noticed it. Couple of questions: Could a displaced rib or old ligament injury present this way since the bump is more prominent when moving the arm behind me? Could this be a lymph node? What presenting characteristics on U/S and/or FNA would you recommend excision to a family member? Correct me if I am wrong, I have read tuberculoma's in this region are rare, how should I get my GP to investigate this as a possibility?
Answered by Dr. T Shobha Deepak 11 minutes later
Brief Answer: X-ray and ultrasound will help differentiate Detailed Answer: Namaste Greetings Displaced bone or ligament will cause gross deformity in this region. It could be even tubercular affection of the lymph node. Thoracic inlet x-ray will rule out possibility of bony or ligament pathology. At this point ultrasound of the region, looking Whether it's homogeneous or cystic followed by ultrasound guided biopsy will help. Decision of excision Will depend on fnac report. I hope I have clarified your doubt. Do get back to me with clinical photograph in case you have further query. Take care Regards Dr T Shobha MBBS MD
Follow-up: Should I be concerned about a lump under my right clavicle? 8 hours later
Thank you Dr. XXXXXXX I've included a picture and marked off the border, the bump is a little smaller than the distance around I've marked and again is palpable with arms at sides and slightly visible with shoulder retracted. I hope this helps. Could costochondritis also cause such a lump? I will still follow your advice to rule out other causes.
Answered by Dr. T Shobha Deepak 14 minutes later
Brief Answer: Ultrasound, xray and fnac required Detailed Answer: Greetings Dear Ms. House From the area marked in the clinical picture provided by you, it appears to be subclavicular lymph node. I hope there is no palpable mass or any other abnormality in the breast. Other possible differential diagnosis would still be 1> Lipoma 2> Costochondritis 3> Implantation dermoid from previous trauma Would suggest you to get 1. X-Ray of Neck and Thoracic inlet 2. Ultrasound of the swelling and Breast (to rule out non-palpable breast abnormality) 3. Fine Needle aspiration of the swelling and cytopathology There is no cause for concern, do get the above investigations done at your convenient time. Do revert back to me if you have any queries anytime. Wish you great health. Take Care Best Regards Dr T Shobha Deepak MBBS MD