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Dr. Thomas, MD
Dr. Thomas, MD, Board Certified Physician
Category: Medical
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Experience:  Internal Medicine--practice all of internal medicine, all ages, family, also Integrative, CAM, etc
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Painful lump at the rib level, below right breast (just to

Customer Question

Painful lump at the rib level, below right breast (just to the right and slightly below the inverted V at the breast bone). This symptom started nearly 6 years ago after having a reaction to Lamasil Oral. It was a on again off again pain. Sometimes going for a couple of weeks with no symptoms. A year ago, it became more persistent. Pain radiating down and around the right side, right side shoulder pain, feeling of fullness in the upper right quadrant. Decision was made by surgeon to remove my gallbladder. Was told that it was diseased. The symptoms improved, although did not entirely disappear. Three months later, the symptoms intensified, same radiating pain into my right side, and right shoulder. Blood tests have shown elevated amylase levels. (144 the first time and 139 when checked 6 weeks later.) It feels as though I have a baseball under my right breast. Muscles spasm and another doctor says I have a rib spasm and puts me on muscle relaxers and pain pills. I have had intense night sweats for the last 8 weeks. The night sweats are becoming increasing worse. Last night I changed my pajamas 4 times and had to lay a towel on my bed, because the bed was soaked. I also experience periods of all over itching, although no rash. My blood pressure although typically low (98 over 65) is now running around 83 over 55. I am having floating feelings when moving eyes, head, body....not 100 percent of the time....but too many times to count....during the day. My ears have been examined by an ENT and he feels it is not coming from my ears. He performed a marching in place test, arms outstretched and eyes closed. During the test I moved forward and to the right. I don't know what it is supposed to mean, other than he said that wasn't entirely normal. Energy levels are low, weight is unchanged. Appetite is normal. I eat many small meals as eating too much increases the upper right quadrant pain and fullness. An ultrasound of the pancreas and liver were normal. I realize I have given you a lot of info, and much of it may be irrelevant... just want you to be able to see the whole picture and come to your own conclusion. The last visit with the gastroenterologist resulted in him giving me injections into a nerve in my upper abdomen. I'm getting a little frustrated and just want to feel better.
Submitted: 3 years ago.
Category: Medical
Expert:  Dr. P. Jyoti replied 3 years ago.
Have you seen an Orthopedician?

Did you get any relief from the injections by the Gastroenterologist? What was the diagnosis given by the Gastroenterologist?


I am available online to help you further with this info.
Customer: replied 3 years ago.
No, I haven't seen an orthopedician.

Absolutely no relief from the injections. I realize that the cortisone injection really should have no bearing on increased pain, so probably a coincidence, but the pain has been worse the last couple of days. Injection was done on this past Tuesday.

No diagnosis given by the gastroenterologist. He said the injection had a 50/50 chance of working. When I asked him about the elevated amylase levels, he just shrugged and said he's not sure and we'll recheck it in 6 months. I really don't want to feel like this for another 6 months
Expert:  Dr. P. Jyoti replied 3 years ago.
You should rule out Costochondritis.

Costochondritis causes pain and inflammation of the rib joints, and this would account for the pain at the site and the lump. It may also radiate to other parts of the rib cage, specially if more than one joint is affected.

Since you have been examined and treated by a gastroenterologist, you need to think of conditions other than GIT problems.

Other conditions like dizziness that you mention would not be caused by costochondritis however.

It is also likely that you are suffering from some stress/depression leading to somatization. link

You should also discuss with your PCP/Family Physician about stress or depression and for anti-stress medicines. If necessary, you may consult a psychiatrist.


I hope my answer has helped you. Please click on the green 'accept' button below for accepting this answer. Feedback/Bonus will be appreciated.


Customer: replied 3 years ago.
I respect your opinions, but question how eating would have an effect on costochondritis. I also don't see where increased amylase levels would play a role in any of the aforementioned diagnosis. There is also no mention of the increased problem of nightsweats, which I might add are followed by chills. I think somatization can be ruled out.
I guess I'm back to square one.
Expert:  Dr. P. Jyoti replied 3 years ago.
You are quite right of course and as I said, costochondritis would not account for the other problems except the pain in the rib region and the lump.

One possible condition that would tie up all your symptoms is Neuroendocrine tumors of the head of the pancreas.

This may cause all your symptoms including increased amylase, night sweats, dizziness, pain in the gastric region and lump.

Neuroendocrine tumors can be of various types and cause a wide variety of symptoms, including the ones you are suffering from and many others besides. There can be various atypical types also.

I did not suggest this as you have already been examined by a gastroenterologist who would have looked for this.

However, you may consult your gastroenterologist again and discuss about this condition.

You can look up here:
http://en.wikipedia.org/wiki/Neuroendocrine_tumor


I hope my answer has helped you. Please click on the green 'accept' button below for accepting this answer. Feedback/Bonus will be appreciated.


Expert:  Dr. Thomas, MD replied 3 years ago.
Hello, I am a board certified internist. The other expert has given you many possibilities.
What further questions do you have?
dt

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