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Ask Dr. Gupta Your Own Question

Dr. Gupta
Dr. Gupta, Pediatrician
Category: Pediatrics
Satisfied Customers: 7840
Experience:  MD, practicing Pediatrician with 19 years of experience. Member American Academy of Pediatrics.
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Concerned Mother

Resolved Question:

I discovered a hard lump under my sons right armpit over 3 weeks ago, it is very noticeable  when he raises his arm straight up or over his head.  This lump does not appear under the left armpit.  I have tried palpating the lump when his arm is down  & can feel the lump but it is much softer and harder to palpate.  He has had no infections, fevers, scratches or been in contact with cats(allergic to cats).  His Right arm and shoulder has no other bumps/bruises.  He has other health issues we are very concerned about though.  I took him back to his Pedi, and the Pedi stated that the lump was a bone, even though the left armpit does not have the same bone sticking out.  I spent hours trying to figure out what bone that could stick out like that but haven't found an answer. We saw a neurosurgeon for his continued headaches today, I happen to ask if he could take a look at this lump and the neuro told me that he was sure it wasn't a bone, and that it appeared to be a lymph node.  Please help me and tell me if there is a bone or bony part of a bone that sticks out in children, or if it is a lymph node. 

Submitted: 1 year ago.
Category: Pediatrics
Expert:  Dr. Gupta replied 1 year ago.

Dr. Gupta :

Hello & welcome! If you have any questions after reading my answer, be sure to let me know.

Dr. Gupta :

From your description & the photographs it appears to be a Lymph node ...

Dr. Gupta :

The location is quite characteristic for the same

Dr. Gupta :

The most likely explanation is a post inflammatory lymphadenopathy

Dr. Gupta :

However, I would like another doctor to have a look to confirm this

Dr. Gupta :

If there is any doubt, the best thing would be to do a Fine needle Aspiration test to find the exact cause of this lymph node swelling

Dr. Gupta :

Can you see the answers? And would like to ask for any clarifications?

Customer:

But is there any way that this could be apart of the bone? Ive been concerned, and was hoping this lump would become smaller or the other armpit "bone" would even out, but this has not happened. My pediatrician did not seem concerned at all, since it is a bone. When I try to palpate this lump with my sons arm down I can't feel the lump well, is this normal if it was a enlarged lymph node, I thought I would be able to palpate regardless of the arm position.

Dr. Gupta :

A lymph node in the arm pit would become less palpable when you are keeping your arm down,

Customer:

How long do you typically need to wait before a lymph node should be tested?

Dr. Gupta :

This is why doctors are expected to palpate for LN in axilla in the arm extended position

Dr. Gupta :

It depends on many variables including if there are any local symptoms (which are none in this case)

Dr. Gupta :

and if there is a rapid increase in size,

Dr. Gupta :

or if there are other lymph nodes that are getting enlarged as well

Dr. Gupta :

In this case, I would suggest a clinical examination again and then consider an FNAC needle biopsy test if the swelling persists

Customer:

As far as I have seen no other lymph nodes are enlarged, but his headaches have increased, he has had many episodes of left upper quadrant pain directly behind the ribs not underneath, the pedi believes this to be due to constipation, is that possible? An abd xray was done today, would an enlarged spleen be seen it that was the case?

Dr. Gupta :

How old is your son?

Dr. Gupta :

Why was the Xray done?

Dr. Gupta :

And any neurological imaging being planned for the headaches?

Customer:

my son is 6, a limited MRI was done 4 weeks ago for headaches and abnormal eye movements, fatigue. Everything came back fine as far as MRI and CBC. But the lump was noticed about a week after that MRI. The Neuro appt was a referral to help determine the reasons for headaches and possible motor tic. I'm not sure why the neuro requested the abd xray, but he said that the abd pain could be due to retained stool.

Dr. Gupta :

Ok

Dr. Gupta :

The normal MRI is reassuring, even if the LN swelling came 1 week afterwards...

Dr. Gupta :

I would recommend a wait & watch approach at the present point of time

Dr. Gupta :

Wait for a few weeks and if the swelling reduces in size, with no local problems

Dr. Gupta :

just ignore it

Dr. Gupta :

On the other hand if it increases or there are local symptoms, FNAC can be considered

Customer:

Ok, thank-you, your advice is greatly appreciated and reassuring, as waiting seems to be the only option.

Dr. Gupta :

I agree, and thanks for your positive comments

Dr. Gupta :

Do leave a positive feedback at the end of the conversation, since this is how we experts are compensated for our time,

Dr. Gupta :

Warm regards

Dr. Gupta :

Dr Gupta, MD

Dr. Gupta, Pediatrician
Category: Pediatrics
Satisfied Customers: 7840
Experience: MD, practicing Pediatrician with 19 years of experience. Member American Academy of Pediatrics.
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