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Have had swelling in chest. What could it be, lymph node related or ue to muscle strain?

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General & Family Physician
Practicing since : 2009
Answered : 93 Questions
Hi, I've had swelling in my chest now for 3 months. Its not painful, and I believe it may be lymph-node related, because I can get the swelling to go down ( by taking XXXXXXX cider vinegar, exercise, etc) but I can not get it to go away. I thought it may be a strained muscle at first because I lift, but I have no pain and the physical therapists Ive talked to at work both said that swelling was strange. I am 22 years old, male, 5'8 about 145 and from Pennsylvania. I am not overweight, like the picture suggests, that is the swelling. Thanks!
Posted Sat, 27 Jul 2013 in Bones, Muscles and Joints
Answered by Dr. Rene Gerard Cruz Galera Jr 2 hours later

Welcome and thank you for your question.

I have read the description of your swelling, what you do to get the swelling subside, and checked your photo.

Based solely on the information you have given and the photo you attached, it is quite difficult to say exactly what the problem is. If the swelling that you are referring to is located in the midline and just below the lower border of your pectoralis muscle, it could just be the insertion (where the muscle is attached) of the pectoralis to your sternum. It may disappear when you exercise because the pectoralis muscle, as a whole, is pumped up and gets rounded out.

I, am however, at a disadvantage because I cannot physically examine the swelling as in a true consult. Could you, please, if possible provide me with the following:
1) When do you notice it appear?
2) How big does it get?
3) What does it feel like when you touch and press on it? Firm like your nose, soft like your lip, or hard like your forehead?
4) Are there any other swelling that you have noticed/seen?
5) Two photos: one where you point to the swelling, and another taken sideways so that I can get an idea of how large it is.

Your answers, together with the photos, will greatly help me in diagnosing your problem despite the limitations of not actually seeing and examining you.

Thank you and I hope to hear from you soon!

Above answer was peer-reviewed by
Follow-up: Have had swelling in chest. What could it be, lymph node related or ue to muscle strain? 3 hours later

Thank you for your answer. If I did not treat it, it would be present all the time, and to an extent it is present all the time at least a little bit. Here's the deal, Im a little embarrassed to admit this but they kind of feel like boobs. My pecs should not feel like this, other than this I am in decent shape and they were never like this before. At one point during the past 3 months I thought it could be gynecomastia. But then I thought it was lymph node swelling because I could seem to get them to get smaller if I did quack remedies like drinking XXXXXXX cider vinegar diluted in water, and putting castor oil on them overnight. To answer your questions in order,

1) It does seem to get bigger after the days after I lift. Other than that its fairly stable unless I stop doing the "quack" remedies.

2) That first pic I sent you is about the limit of how big it gets, so not huge, but definitely noticeable for me.

3) Feels soft like a lip. Almost like there's fluid underneath

4) I have not noticed any other swelling, the swelling that I believe I have collects in my pec, like as a whole. My left pec is bigger than my right

5) I dont know if I can send you pics on this response, but Ill get them to you.

One more thing. I know it is possible its gynecomastia, I did not take steroids but I was taking moomiyo on a fairly regular basis after workouts.
Answered by Dr. Rene Gerard Cruz Galera Jr 1 hour later
Hi! I appreciate that you got around to revert to me quickly.

Thank you for telling me how you feel too, I am sincerely grateful for the trust you've shown. I am also glad that you were able to send in those additional pictures. This now leads me in the right direction - they are not the insertion points of your pecs.

Let me sum up everything you've told me so far (please correct me if I got anything wrong):
1) You've felt this swelling start 3 months ago
2) It feels soft like a lip with some fluid underneath
3) The swelling gets bigger post workout and subsides with the application of home remedies
4) you believe it's either a swelling of the lymph node or gynecomastia
5) you take synthroid 25mg and moomiyo

Now, for some more questions that I have:
a) Is there a well-defined mass that you feel when you touch it - in other words, does it feel like a cyst or a lump? Or is it a more generalized, soft, swelling with no borders?
b) Would you, by any chance, remember if the specific area was hit/traumatized either through sports, ordinary activity or play?
c) How long have you taken synthroid and for what purpose?

If the swelling is cystic/like a lump:
Cysts can be found in breast tissue (for both males and females). It is a collection of fluid that can be blood if the particular area was injured/hit during sports or other activities, or clear serum-like fluid that is due to hormonal changes that occur in the body. Cysts can disappear spontaneously without any management. But if it turns painful or enlarges progressively, you have to see a surgeon so that he/she can run some tests and either aspirate the fluid or remove the cyst surgically.

If the swelling is more generalized:
Gynecomastia, on the other hand, can be due to several causes (and yes, you are correct that steroid intake can cause this) including aging, liver disease, malnutrition, kidney failure, tumors and cancer, and hyperthyroidism. Now, the intake of synthroid, which is a thyroid hormone, can cause pseudohyperthyroidism (especially if the dosage is not tailored or monitored carefully) which may lead to a hormonal imbalance (including our sex hormones) and thus induce a temporary gynecomastia. Now, gynecomastia can occur unilaterally and look asymmetrical. If you're taking the synthroid for hypothyroidism, just talk to your endocrinologist so that he/she can check if your thyroid levels are still well within the normal range and so that the dosage can be adjusted accordingly.

I wish I was able to clear some things for you and I hope to hear from you soon!

Above answer was peer-reviewed by
Follow-up: Have had swelling in chest. What could it be, lymph node related or ue to muscle strain? 20 hours later
You have everything right, except for the moomiyo part I stopped taking that about 2 1/2 months ago.

It is a more generalized swelling, there doesn't seem to be well defined borders except its limited to the pec muscle itself. I don't remember it being injured, and I don't remember feeling anything pull at the gym, thats why I thought the swelling was so strange, because I had no pain whatsoever. I've taken synthroid, I believe, for at least a year and a half now if not two years. I was symptomatic for hypothyroidism and my t4 levels were just below normal. Before taking it I had difficulty waking up, staying concentrated, and with motivation, but after taking it felt much better. Its possible that I am slightly hyperthyroid now though. I am going to talk to my endocrinologist this week. Thanks a lot for pointing that out.
Answered by Dr. Rene Gerard Cruz Galera Jr 3 hours later
You are very much welcome.

I also have to point out that, there is a slight possibility that your thyroid levels are normal all along. This asymmetry or "swelling" may just as well be a normal variation of 1) an accumulation of fat that you can burn; or 2) that your right pectoralis is really slightly bigger than your left (especially if you are right handed).

If this is the case, it's just the way your body is right now. All individuals are not symmetric in one way or another - although some are slightly more symmetric than others. You may try doing cardio exercises or strengthen your left pectoralis to achieve balance and improve symmetry. But all in all, if your thyroid tests and other tests that your endocrinologist requests come back normal, you really have nothing to worry about. You seem like a very healthy young man and your physique is actually coming out nicely.

I really hope you can maintain doing regular exercises/workouts (remember to stretch and warm up!) and eating a healthy balanced diet. These will matter in the future and will help prevent a lot of chronic diseases like diabetes and heart problems.

I hope I was able to address your concerns adequately. If you have any other questions, I will be happy to help. If not, you can close the discussion and rate the answer. Take care and I wish you well!


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