EXAMINATION OF

SOFT TISSUE
SWELLING

Ayshathunoora

2020
INTRODUCTIO
N
A swelling is a vague term
which denotes any
enlargement or
protuberance in the body
due to any cause.
 ETIOLOGY OF
SWELLING
-CONGENITAL
-TRAUMA
-INFLAMMATORY CONDITONS
-NEOPLASTIC
-MISCELLANEOUS
HISTORY TO BE TAKEN FROM THE
PATIENT
❑ Duration of Swelling:
-How long is the swelling present there?
- When was swelling noticed for the first time?
a) If Congenital Swelling –likely to be present since birth
b) Swelling with shorter durartion (WITH PAIN)-Mostly Inflammatory
c)Swelling with shorter duration (PAINLESS) – Neoplastic/Mostly
Malignant.
d) Swelling with longer duration (WITHOUT PAIN) – neoplastic[benign]
e) Swelling with longer duration (WITH PAIN) – Chronic Inflammatory
swelling
❑ Mode Of Onset:
-How did the Swelling start?
a) It may have developed just after a Trauma? ( #displacement of
bone,hematoma,etc)
b) It May have developed suddenly and grow rapidly with Severe Pain?
(Inflammatory)
c) It may have noticed casually and gradually increasing in size? (Neoplasm)
d) May occur from Pre-existing Conditions.eg.keloid from scar
 PAIN-It is the most common complaint of traumatic and inflammatory
swellings.
-But pain may be absent in neoplastic (MALIGNANT) swelling.
Nature:
Throbbing- Inflammation leading to Suppuration.
Stabbing/Lancinating- Pain is sudden,Sharp,Severe with Short Duration.
Site:
Sometimes Pain is referred to some other site than the affected one,
(Ex- IN CASE of affection of hip joint ,pain may be referred to corresponding
knee joint.)
Time Of Onset :
a) Whether the pain precedes the swelling? (Inflammatory Swelling)
b) Swelling preceded the pain? (Benign & Malignant Swellings). exp:
Osteosarcoma.
PROGRESSION OF THE
SWELLING
-Is there any change in the size of the swelling
since it was first noticed?
Benign Swellings-Grow Very slowly/Remain Static for a long time.
Malignant Swellings- Grows Very Rapidly.
Malignant Transformation of Benign Growths- Suddenly increases in size
after remaining static for a longer time.
EXACT
SITE:
If Small Swelling-Easy to inspect the exact site.

If Swelling is large-Exact site of the swelling can

be identified by asking patient to show the exact site
from where the swelling has originated at his/her
first notice.
FEVER:
Is there any rise in body temperature?

Recurrence of Swelling:
Recurrence even after the removal of cause indicates
malignant change in benign growth.
-Some Swelling’s recur commonly .Ex. Pagets
recurrent fibroid
-Cystic swelling may recur if cyst wall is not
completely removed.
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PERSONAL
HISTORY:
-Whether the Patient is having habit of eating Betal Nut,Slaked Lime/Tobacco should
be asked.

Family history-tb, many malignant tumours recurs among family members

 PHYSICAL
EXAMINATION
-General Physical Examination is considered if the swelling is
INFLAMMATORY or NEOPLASTIC.
-Check for the signs of malnutrition,
Loss Of Body Weight
Bleeding Gums
Low Blood Pressure
Low Heart Rate
Minimal Body Fat

-Increased Body Temperature

Signs Of Inflammatory Swellings.
-Increased Pulse Rate

Check the attitude of patient-

 LOCAL
EXAMINATION
INSPECTION:

A) Situation:
Few swellings are peculiar in their positions,
Ex-Dermoid Cyst- (Seen at the Midline of the body)

B) Colour:
Colour gives a clue for diagnosis
Ex- Black- Benign Nevus,Melanoma
Red/Purple-Heamangioma.
Blue- Ranula
C)
SHAPE:
-Ovoid/Pear shaped/Spherical/Irregular
-Never mention as CIRCULAR as we don’t know deeper dimension of
swelling,mention it as SPHERICAL.

D) Size:
-Horizontal and vertical dimensions are noted in centimeters.

E) Surface:
-Difficult to diagnose by surface but few cases have peculiar surfaces like
i) Cauliflower Surface-Squamous Cell Carcinoma.
ii) Filliform Branched Surface-Papilloma
F) EDGE:
MAY BE CLEARLY DEFINED OR INDISTINCT.
SWELLING MAY BE PEDUNCULATED OR SESSILE
G)
NUMBER:
Single/Solitary-Eg-Cyst, Lipoma
Multiple-Eg- Tubercular Lymphadenitis, Neurofibromatosis
I) IMPULSE ON COUGHING:
Swellings which are in continuity with
Cranial Cavity,
Spinal Cavity,
Abdominal Cavity,
Pleural Cavity will give Impulse on cough.
In Children Crying can be considered to examine Impulse Eg-MENINGOCOELE

Examination:
-Ask Patient to Cough and inspect swelling,
If visible increase in size of the swelling gives Positive result.
-Movement of the swelling without expansion or an increase in tension is not
a cough impulse.
L) SKIN OVER THE
SWELLING:
If the skin over the swelling is,

Red & Edematous- INFLAMMATORY

Tense,Glossy with Venous Prominence- SARCOMA
Black Punctum Over the Swelling- SEBACEOUS CYST
Orange Peel Appearance- breast carcinoma
PALPATION:
A) Temperature:
Local Temperature will be raised due to increased Vascularity of
swelling due to infection or Well Vascularisedtumour(SARCOMA).

Temperature can be Examined by placing the BACK OF FINGERS over the swelling.
B)
TENDERNESS:
Pain on exerting pressure over the swelling is termed as
TENDERNESS.

Inflammatory Swellings are always TENDER.

Neoplastic Swellings may or may not be TENDER.

Place fingers over the swelling and gently apply pressure,and

Observe patient’s Face to know wheather swelling is tender or not.
C)
PULSATION:
Swellings arising from arteries are pulsatile.E.g-ANEURYSMS
-Pulsations due to presence of swelling just superficial to the artery, termed
as TRANSMITTED PULSATIONS.it can be examined by placing fingers over the
swelling In case your fingers will move upwards it is termed as Transmitted.

-Pulsations of Swellings arising from ARTERIAL WALLS are-

EXPANSILE PULSATIONS.It can be examined as similar to the above
mentioned but if your fingers move outwards (not only raised but also
separated) it can be confirmed as Expansile Ex-ANEURSYMS
D) SIZE,SHAPE &
EXTENT:
-By Palpation,we can get the depth of invasion of swelling.
-Vertical & Horizontal dimensions are confirmed by palpation.
E)
SURFACE:
-Surface of the swelling is palpated by the PALMAR SURFACES OF FINGERS.

- If the surface is,

Smooth- CYST
Lobular with Smooth Bumps- LIPOMA
Nodular- LYMPH NODES
Irregular & Rough- CARCINOMA
F) EDGE/MARGIN:
Very Important aspect of Palpation,

-Neoplastic & Chronic Inflammatory Swellings -WELL-DIFINED MARGINS.

-Benign - SMOOTH MARGINS
-Malignant - IRREGULAR
-Acute Inflammatory - ILL DEFINED

PROCEDURE- By The Tips Of Fingers.

SLIP SIGN:
Slip sign to differentiate between lipoma and cystic
swelling(both have well defined ,regular borders) when edge of
a swelling is palpated with a finger ,if it slips AWAY FROM
PALPATING finger then it is a lipoma,if it yields to finger,it is a
cyst
G)
CONSISTENCY
:
Very Soft to Stony Hard depending upon the contents of the swelling.

Soft – Lipoma,Cysts &Chronic abscesses

Firm –Fibroma
Hard but yielding-Chondroma
Bony hard-Osteoma
Stony hard- Carcinoma
Variable consistency- Malignancy
H)
FLUCTUATION
: Fluctuation is POSTIVE if the swelling has liquid or gas.

Procedure- By one Finger of each hand

Sudden Pressure applied on one pole of swelling

Pressure with in the swelling increases

Transmits pressure equally at right angles.

Another finger is placed on the opposite pole

Finger raises slowly by itself due to increased pressure.

FLUCTUATION-POSITIVE.
I) TRANSILLUMINATION:

Transmission of light through a swelling

Transillumination-POSITIVE in swellings containing clear fluid and thin

transparent walls

Transillumination-NEGATIVE if wall is thick, or turbid fluid is present(blood,pus,

lymph)

-It has to be done in a dark room ,

with transilluminoscope.
J)
REDUCIBILITY:
-Swelling is compressed from all the sides uniformly
-Reducible swellings decreases in size or completely disappear.

REDUCIBLE SWELLINGS:
Reducible Swellings,Eg-Meningocele

K) Compressibility:
Compressibility when pressure is applied to a swelling,it decreases in size and when
pressure is released,swelling regains its size itself with out any external factors like
coughing

Eg-Charectaristic sign of Vascular Haemangioma

L) FIXITY TO
SKIN:
Skin is pinched over different areas of the swelling

-Non Pinchable -if fixed to skin

-Pinchable-Not fixed to skin.
M) REGIONAL LYMPH
NODES:
Regional draining lymph nodes examined

-If involved next higher group examined

-If the swelling itself is a lymph node examine
Other lymph nodal groups
-Usually of little value in defining a mass with the exception of some abdominal
swellings.

Auscultation
-all pulsatile swelling should be auscultated.
-For example, 'bruit' may be heard over large tumour,
Vascular goiter and arterial aneurysms.
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MOVEMENTS

Movements of the nearby joint should be examined to find out

if the swelling has involved the joint or not.
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