Unearthing the Mysterious Axillary Lump

CC

Mrs. Kelly is a 42-year-old female here today complaining of a lump in her left armpit.

HPI

The patient tells me at least six or eight weeks ago, she noticed that she was having some discomfort in the left axillary area. She around the same time had started doing a lot of exercising, specifically Zumba classes and attributed her discomfort to that. She describes it as an aching, nagging type of pain that is not there consistently. It seems to come and go. Yesterday, she did Zumba and noticed following that it was little bit achy and last evening she was lying down with her arm above her head and was checking the area where it was tender and felt a lump there. This is the first time she felt a lump, despite multiple checks previously.

She thought she should come in to have it evaluated. Since she has noticed the lump, she has been checking the area fairly frequently, but prior to that had not been over manipulating the armpit. She tells me she does regular breast exams. She has not noticed any lumps or problems there. She had a clinical breast exam here in the office in March and a mammogram in April, all of which were normal. She does not notice anything on the right side. She has not had any redness. There has not been any drainage. She does shave the axillary area and use deodorant. She has not had any issues with fevers, night sweats or chills. No nausea, vomiting, or diarrhea and she is otherwise feeling well.

Medications
Include fish oil, CoQ10, Synthroid 0.075 mg daily, red yeast rice supplement.

Social History
She is a lifetime nonsmoker.

O
Vital Signs
Temperature: 98.1.

BP: 128/72. HR: 70. R: 14. W: 207.

General

A well-developed, well-nourished female seated comfortably in the exam room. She is alert and oriented. Very pleasant.

Skin

Her bilateral axillary areas were examined. She does have some fullness in the left axilla, separate from where she felt the lump. On my exam, there is perhaps just a 2 mm superficial mass noted that corresponds to her area of pain. However, I feel fullness in the more medial side, as well as the more lateral side, where she is not having discomfort. Examination of the right axillary area is normal.

A/P

Heather Kelly is a 42-year-old female here today with pain and a lump in the left axillary area. I am also concerned for some fullness that I feel that. I talked with her about the options. I am going to have her do an ultrasound of that area and I will review results with her when available. Should her symptoms change over the weekend, she can certainly seek care if necessary, though I suspect that will be necessary. I have asked her to avoid over manipulating the area, as she may inadvertently make that worse. She was comfortable this plan. She will contact me with questions or concerns. All questions were answered in the office

today.