Question

A 45-year-old patient presents with swelling in the axillary region.
What relevant history and examination would you like to do?

Hint:

A careful history and physical examination will help distinguish between infectious, benign, and malignant causes of axillary swelling. Always perform a breast examination in female patients presenting with axillary masses.

Answer 1

Step 1: Relevant History.
- Onset and Duration: When did the swelling begin? Is it sudden or gradual? A sudden onset may suggest infection or trauma, while gradual onset could indicate a tumor or benign lesion.
- Pain: Is the swelling painful or tender? Tenderness can point to an infection or abscess.
- Associated Symptoms: Ask about systemic symptoms such as fever, weight loss, or night sweats, which could suggest malignancy or infection.
- Risk Factors: Inquire about a history of breast cancer, immunosuppression (e.g., HIV, chemotherapy), recent infections, or trauma.
- Family History: A family history of cancer (especially breast cancer) or autoimmune conditions may be relevant.

Step 2: Physical Examination.
- Inspection: Examine the axilla for any visible swelling, redness, or warmth. Look for signs of infection such as abscess or erythema.
- Palpation: Palpate the axillary region to assess the size, consistency, and mobility of the swelling. A firm, fixed mass may suggest malignancy, while a soft, mobile mass may indicate a benign condition like a lipoma.
- Lymph Node Examination: Examine other regional lymph nodes (e.g., cervical, supraclavicular) for signs of generalized lymphadenopathy, which can point to systemic causes.
- Breast Examination: Conduct a thorough breast examination to check for any masses or skin changes that could indicate breast cancer or metastasis.
- Other Systems: Check for signs of systemic infection, such as fever, and assess for signs of hidradenitis suppurativa, such as abscesses or draining sinuses.

Step 3: Conclusion.
A detailed history and physical examination are crucial in differentiating the cause of axillary swelling. Further investigations may be required based on clinical findings.