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Dr. Rick, MD
Dr. Rick, MD, Board Certified MD
Category: Medical
Satisfied Customers: 11267
Experience:  20+ years as a doctor. Internal Medicine Internship in NYC
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I Have A Lump On My Abdomen. Should I Be Worried?

Customer Question

Soft/firm lump on far left side of abdomen just below the ribcage. This problem has been rattling me for about 2 months now since I discovered it. I'm 39, male, and at least somewhat overweight (have belly fat). The lump is something I just sort of found. It sits just below my ribcage on the left, almost on the left edge of my torso, but in just an inch or two. It's more pronounced and easier to find when standing, and more so if I stretch and draw in my abdominal muscles. Its about 2 inches or so, and kind of loosely defined. I can hold in the palm of my hand, and in the mirror, it can be seen slightly beneath the skin when standing. It feels attached to my abdominal muscle, and it's got a relaxed muscle type feel. I can't move it around, but it's soft enough to be compressed in/out. When I really try to feel it, it seems vaguely connected to something else in my body. More like a swelling area if anything else, if that makes sense. It's warm to the touch, does not pulse, and poking it doesn't seem to produce any direct pain. I also *think* I have some pain and swelling in this area, but it's of course hard for me to tell. To me, the feeling of and around the lump is a "muscular" or "colon" type nature. Occasionally I'll get some vague pain or internal itching sensation from it. Sometimes, when I try to sleep on the left side, I can feel a pressure from it. However, all of this I think is also exaggerated a bit because this is a new problem I'm trying to figure out. I've seen a doctor about this, and despite really "feeling" up my body, he was at first unable to feel any particular lump. He said my colon felt full. He then suggested we could do an ultrasound of that area. I finally got in for the ultrasound and it came back with no abnormalities, and a spleen that is "on the upper limit of normal size". The only other connections I think I can feel towards this lump are anything with my stomach, such as gas pain or indigestion, and I *think* if/when I occasionally drink the lump will be worse or feel more firm the next day. However, I can't really say for sure on the drinking, as I drink only occasionally and have noticed varying conditions on it the next day, even with a hangover. The lump doesn't appear to be going anywhere, and I could possibly live with it, but I'm trying to get a second opinion here. The other problem is the next step is CT scan, and I'm already struggling a lot here uninsured, so the CT scan may simply not be affordable for me for sometime, unless it is some sort of emergency. What is this lump likely to be?

Submitted: 4 years ago.
Category: Medical
Expert:  Dr. Rick, MD replied 4 years ago.

Thanks for that very in-depth discussion about this lump. I am glad to see that you have had an MD look at it and had an ultrasound done and everything came back OK. As to your next step, I would suggest an MRI instead of a CT scan since you are looking for a possible soft tissue mass, which CT scan does not show as well as MRI. As to what it could be? My first guess would be a lipoma, maybe some sort of cyst or, less likely, a hernia. Truthfully, given the negative physical exam and ultrasound it is hard to tell what it could be. Maybe it is just a collection of normal tissue that you are feeling. In any event, if there is anything present, be it an abnormal mass or an unusual collection of normal tissue, an MRI will not miss something large enough for you to hold in the palm of your hand.

Customer: replied 4 years ago.

Well, I was hoping for some more "odds" on this. The MRI is a ridiculously expensive procedure, and if the chances of this not being cancer are high, I'd like to know if I could avoid that for at least some time. Not that you asked, but I haven't had any other very noticeable changes in health. The only thing that has me a bit alarmed is that I had a very long bout of shortness of breathe earlier this year. It also was never conclusively diagnosed, although hypertension and high cholesterol were found to be issues. It got so bad once, that I went to the ER, but again the visit wasn't necessary because nothing was really done. After that, I paid for a CT Scan "with calcium score" to check for possible heart vessel blockage. According to the doctor , this test came back completely clear, which I find puzzling at my age and current health. Health is OK, and do exercise regularly, and have a fairly good diet, but I'm not sure how I can have no plaque at all.

I've recently gone on "linsopril" to reduce blood pressure, and it appears to work well. Also making other positive changes, however I do drink occasionally (few times a week) and smoke cigars (not inhale). The cigar habit is about 3 years old, so I have a heightened fear of things like stomach cancer, etc. As I understand it, that's the other major organ near this area.

Finally, I'd like to mention that the sensations around this lump, which is really more like a swelling than a lump, seem to tie the most into my colon in that area. For my entire life, I've been prone to spastic colon and generally a lot more loose bowels than firm, although in recent years the painful attacks have mostly subsided, and those almost always seem to be brought on by stress and diet. One recent change I've made in my diet prior to this problem is an almost daily regimen of fiber supplement. I don't really measure the stuff, but I usually have one to two servings of psyl husk in water. With an already overactive colon, I wonder if this is having any impact on my conditions here?

Like most people, I just want to know the likelihood of this being cancerous, since of course whenever you search something about LUMPS on the internet, you'll be nearly convinced you have cancer or some serious disease every time :-/

Expert:  Dr. Rick, MD replied 4 years ago.

It is hard to give odds, other than to say the fact that you have had a normal physical exam and ultrasound rule out the vast majority of worrisome problems. I agree that an MRI is much more expensive then a CT scan. That being said, since you are looking for a soft tissue issue, MRI is the way to go. Why pay less for an imaging modality that, if it doesn't show anything you will wonder if it only because it missed what was there? At this point I would not put cancer very high on my list of differential diagnosis issues so I wouldn't worry about that right now. As to your plaque free coronary arteries, once again a CT scan with a "calcium score" is not the imaging method of choice to detect this type of pathology. A coronary angiogram is the way to go for this issue. I am glad to hear that you share some traits with President Clinton but inhaling or not inhaling cigar smoke is not really that germain when it comes to calculating your risk of stomach cancer. Also, you would have other symptoms and/or findings on the ultrasound if you had this disease. The fiber intake is a very good idea and would not be expected to cause any abnormal feelings or mass in this area. As a JA expert, you know that you should not search the internet as Mr. Google is just chock full of scary advice that usually does not apply to your particular situation. I do not think that you have to worry that this bump/mass/feeling thing below your ribcage is a cancer or anything else real serious. That being said, if you really want to know, without a doubt, what is or is not there a MRI is the way to go. The only way to be more sure about what, if anything, is present in this area is to have a surgeon open you up and take a look which, of course, is not something you would do.

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Customer: replied 4 years ago.
Thanks Dr. Rick! I have an appointment with my new Doctor, so I'll also be following up with him. It's good to know the MRI is a good option here, but of course not so good in our very unaffordable medical system in this country. I suspect my Doctor will suggest something along the lines of putting a watch on this condition, and to pursue more scans if another symptom develops or the situation worsens.

One more followup point if possible, that I guess I didn't make clear with all the details I had given. Is there any likelihood of some sort of inflammatory condition with my colon or other organ near the area of this lump? I'm asking because like I said, it's more of a swelling than a lump, and I do have those pressure and mild pain type sensations, which leads me to believe some anti-inflammatory drug or related treatment might help.
Expert:  Dr. Rick, MD replied 4 years ago.
While it is possible, I do not think that is a likely cause.
But, once again, an MRI would easily show anything like that as well as anything else that might be going on.