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Having knot like thing on lower portion of rib cage. Diagnosed with mono 2. Spleen enlarged. Prescribed Doxycycline. Guide?

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General & Family Physician
Practicing since : 2004
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I am having some problems and went to the doctor today to get blood work done and tomorrow I am getting an X-ray for this problem..

I have a knot like (small fist size) on the lower portion of my rib cage on the LEFT side. To describe the location its on the lower part of my left rib cage and lines up to my nipple (directly below my nipple, just under the ribs). It's almost the shape of a pyramid sticking out. And it is a hard like knot.

I was diagnosed with mono 2 months ago, however I noticed the knot about 3 weeks prior to being diagnosed. Today at the doctor I told him my problem and he felt my spleen and said it MAY be enlarged a little bit, but his thoughts say that my knot on my rib cage is something other than the spleen.

I wouldn't call it painful as much as I would say its really uncomfortable. I can tell it's there; and below I will describe all my symptoms....
- Dizziness when I stand up from laying down or sitting down
- Fatigue
- Under my knot in lwr left abdomen I get a tingling sensation as well as sometimes a burning sensation. (Not a bad burning)
- Sometimes while laying on my stomach my abdomen and chest get a numb feeling
- The only sharp pain is in lower left abdomen and lower right back and it's more like a sharp gas pain.
- My knot spot is tender to the touch
- Very bad taste in my mouth
- Sweaty/Sticky feeling sometimes
- When pressure is applied to lower left abdomen it hurts a little bit
- Frequent headaches
- Every now and then sleep paralysis
- Knot is sensitive. (-When I have a shirt on I can feel it touching my knot).
- Not really increased but a strong heartbeat (Only when I take my adderall)

It feels like when I burp it makes it better as well as when I have gas.

Medications I am taking that ARE all prescribed by my doctor(s).
- Adderall generic brand Amphetamine Salts 30mg instant release. 90mg per day is what I typically take. I have told my doctor about the extra pill(s) I take a day.

- Doxycycline was prescribed to me by my dermatologist before I was prescribed adderall. I was off of this medication for about a year and then started again 2 weeks ago, however, it made me sick to my stomach and gave me diarrhea. (I took adderall those days as well).

- Every now and again I will take tylenol PM to help me go to sleep when I have insomnia from my adderall.

OTHER THINGS THAT MAY BE IMPORTANT- I'm not sure if any of these effect it or not.
- I'm a pilot, so I'm going up to high altitudes every day. Around 4,500ft.
- Before mono, I had my wisdom teeth taken out and maybe had an infection in those pockets, I'm not sure
- I USE to take more adderall than prescribed- sometimes up to 6 a day which is 180mg to help me stay awake through flights. However after help, I am taking usual amount which is 3 a day at 90mg.
- Because of adderall I have had many sleepless nights causing me to be tired and restless all day
- I drink a lot of water because I usually have a dry mouth.

Thank you for you're time in reading this and I hope I can get a general idea of what the heck is going on since my doctor seems clueless! I'm really scared and worried.

Posted Tue, 8 Oct 2013 in General Health
Answered by Dr. Chakravarthy Mazumdar 4 hours later
Brief Answer: XXXXXXX a general surgeon

Detailed Answer:

It looks like the pyramid like lump that is appearing over the skin is fixed to the underlying structure. If it is not moving it should be arising from the rib, diaphragm or the muscles attached the rib. The location appears to be arising from these structures. Since your doctor confirmed that the spleen is separately palpable I would think of the lesion coming the above structures.

If it is coming out from the diaphragm it would move on inspiration or expiration, is it? If not then ribs and intercostal muscles would be attached to it.

The consistency of the structure is important too to determine the possible causes. If it is soft then hiatal hernia can be thought about but unlikely at this location.

I think you should head to general surgeon who are experts in diagnosing such conditions. Ask your GP/PCP for a referral. If they are not able to then they can refer to investigations. Do not worry investigations like CT scan or MRI would easily detect what that lump is about and what can be done.

Hope you understand my drawback of not being able to examine you to give a clear cut picture. Please get back to me after you visit the general surgeon, I would be interested to follow up.
Above answer was peer-reviewed by
Follow-up: Having knot like thing on lower portion of rib cage. Diagnosed with mono 2. Spleen enlarged. Prescribed Doxycycline. Guide? 12 minutes later
Thanks so much for your feedback, I most certainly will try and XXXXXXX with a general surgeon.

The lump is not moving. It is in one spot only and stays there. I can't imagine what it would be. I didn't know if it could be the spleen or what.. My doctor never confirmed my spleen being separately palpable. All he could tell me was that it COULD be enlarged because my muscles were tight when he was pressing on it. Thats the only feedback he gave me.

I'm wondering if this lump is from mono or something. I still believe it's spleen related. But I'm not a doctor so my belief(s) aren't really what I'm going off of.
Answered by Dr. Chakravarthy Mazumdar 39 minutes later
Brief Answer:
Examination makes things better

Detailed Answer:
The location does not seem to splenic. It looks to be over the rib cage. Spleen is under the rib cage and splenic enlargements are not visible they are only palpable in adults.

You have a point too we have seen large splenic enlargements in Mononucleosis.

However a proper examination by General surgeon would make things much clearer.
Above answer was peer-reviewed by
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