EXTREMITY MASS
When the clinician tries to recall the causes of a mass in the
extremities, he or she should consider the anatomy. As the clinician
dissects downward from the skin, he or she encounters the subcutaneous
tissue, veins, muscles, ligaments, bursae, arteries, lymph nodes, nerves,
bones, and joints. The common lesions causing a mass in each of these should
easily come to mind.
-
Skin. Common lesions to consider here are sebaceous cysts, lipomas,
and cellulitis. Other skin masses are considered on page 396.
-
Subcutaneous tissue. Rheumatic or rheumatoid nodules, tophi of
gout, lipomas, and contusions are common.
-
Veins. Dilated veins (varicoceles) and thrombophlebitis present as
mass lesions.
-
Muscles and ligaments. Contusions, nodules in myo-
fascitis, ganglions, and partial or complete rupture of muscle (e.g., rupture of the
rectus femoris) are typical masses originating in the muscles and ligaments.
Myositis ossificans may present with nodular masses.
-
Bursae. The bursae may be involved by gout, trauma, or rheumatic
conditions and swell with fluid.
-
Arteries. Aneurysms are the most likely cause of an extremity mass
originating from the arteries. Severe arteriosclerosis may cause confusion
occasionally.
-
Lymph nodes. Tuberculous adenitis, adenitis secondary to infections
in the distal portion of the extremity, and metastatic tumors may cause
enlargement of the lymph nodes.
-
Nerves. Traumatic neuromas, neurofibromas, and hypertrophy of the
nerve in Dejerine–Sottas disease are typical “masses” arising from the
peripheral nerve.
-
Bone. Trauma may lead to fractures and subperiosteal hematomas,
callus formation following the fracture, or secondary osteomyelitis, all of
which may cause a mass. Primary osteomyelitis, tuberculosis of the bone,
syphilis of the bone, rickets, and acromegaly may cause bone masses. Typical
tumors affecting the bone are chondromas, exostoses (osteomas), osteogenic
sarcomas, fibrosarcomas, and metastatic carcinomas, but there are several
others. Paget disease may present as an enlargement of the bone.
Approach to the Diagnosis
If the lesion is suspected to arise in the skin, simple biopsy or
excision is the best approach. Deeper masses require careful examination,
x-rays of the bones and soft tissue, bone scans, CT scans, ultrasonographic
studies, and phlebography, arteriography, or lymphangiography. Surgical
exploration of the area may be the only means to accomplish a specific
diagnosis.
Approach to the Diagnosis
Because the extremities are not considered vital areas, the primary method
of diagnosing the cause of a mass is exploration and biopsy. This is all
well and good when the lesion is on the skin or subcutaneous tissue;
however, when the mass is in the deeper tissues, it is wise to utilize
diagnostic tests to determine what the mass is before exploration. If the
mass is suspected to be a varix or aneurysm, ultrasonography can be
extremely useful in defining it. If the mass is attached to or thought to
originate in bone, x-rays of the area and bone scans are useful. If it is
uncertain what tissue the mass originates from, a CT scan can be used to
help define it. Before ordering any of the above tests, it is best to
consult a general or orthopedic surgeon to help select the most appropriate
test for the case at hand.
Other Useful Tests
-
CBC (abscess)
-
Sedimentation rate (cellulitis)
-
Tuberculin test (cold abscess)
-
Serum protein electrophoresis (multiple myeloma)
-
Skeletal surgery (metastatic neoplasm)
-
Arteriogram (aneurysm)
-
Phlebogram (varix)
-
Lymphangiogram (Hodgkin lymphoma, lymph node metastasis)
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Exploratory surgery
Pictures
Book Source Details
- Book Title: Differential Diagnosis in Primary Care
- Author(s): R. Douglas Collins MD, FACP
- Year of Publication: 2007
- Copyright Details: Differential Diagnosis in Primary Care, Copyright © 2007 Lippincott Williams & Wilkins.
Other Book Chapters Related to Breast lump
Read excerpts from these other book chapters related to Breast lump:
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- FACE MASS
- "Differential Diagnosis in Primary Care" (2007)
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Copyright Details: Differential Diagnosis in Primary Care, Copyright © 2008 Williams & Wilkins.
More About Causes of Breast lump
» Next page: FACE MASS (Differential Diagnosis in Primary Care)
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