EXAMINATION OF A MASS
ETIOLOGY
Generally lumps fall into one of the following aetiological
categories:
• Congenital or acquired.
• Traumatic.
• Inflammatory (acute or chronic).
• Neoplastic (benign or malignant, primary or secondary).
• Other (degenerative, metabolic, parasitic, hormonal/
endocrine disorder).
HISTORY
• Where was the lump found?
• When was the lump first noticed?
• Has it changed in size since?
• Is it painful?
• Are there any other lumps or associated symptoms?
• Is there any history of travel?
• Is there any history of trauma?
• Is there any history of illness, present or past?
PREPARATION
• Wash your hands
• Introduce yourself
• Identity of patient (confirm)
• Permission (consent and explain examination)
• Pain?
• Privacy
• Exposure
Examination
• Site
• Anatomical location
• Relationship to surrounding structures
• Size:
• Size can be estimated but ideally should be measured using a tape
measure or ruler
• should be stated in at least two dimensions (and three where
possible)
• Shape
• Descriptions should be made in geometrical terms where possible
(e.g. spherical, oval, round etc.)
• Surface
• Smooth vs irregular
• Edges: well defined or ill defined
• Consistency
• hard, firm or soft
Hard lumps suggest the possibility of cancer
Soft lumps are more likely to be benign (e.g. lipoma)
• Temperature and tenderness
• Fluctuance
• Suggestive of a fluid filled or fat filled lump
• Mobility
• Is the mass freely mobile or fixed in place
• Lesions that lie superficial to a muscle group should be
tested for mobility with the underlying muscles
both relaxed and contracted
• If a previously mobile lump becomes fixed on contraction
of the underlying muscles it is likely that the lesion has
infiltrated the muscle layer
• Transillumination
• swelling containing
clear fluid will glow
when this test is
performed: Simple
cyst, Hydrocele, Cystic
hygroma
• Reducibility
• Can the lump be reduced? Apply gentle pressure to the
lump, and if it disappears then it is reducible (e.g. inguinal
hernia)
• Pulsatility
• Suggests a vascular etiology
• Transmitted pulsations vs intrinsic pulsation
• Percussion – limited value in assessing most lumps
• Auscultation (bruits, murmurs & bowel sounds)
• Auscultation may confirm findings in the preceding
examination.
• Typical findings include bruits/murmurs over vascular
lesions or areas with an abnormally increased blood
supply (e.g. enlarged thyroid) and bowel sounds heard
over an inguinal hernia
• Examination should be completed with a specific
examination of the lymph nodes which drain the site of the
lump, followed by a general assessment of the patient, with
particular attention being paid to eliciting signs of systemic
infection or malignancy
• A - a cyst on the
dorsum of a hand
• B - a goitre
• C - posterior triangle
lymphadenopathy
• D - an umbilical
hernia
Example
• There is a hemispherical shaped lump, over the left
lateral aspect of the neck, measuring 5cm x 5cm in
size. The overlying skin looks normal. Its surface is
smooth and the edge is well defined. It is mobile and
not attached to the skin or the underlying structures.
It is soft in consistency, fluctuant and transilluminant.
It is not reducible or pulsatile and there is no
associated lymphadenopathy.