• A 50 years old male Mr.Raja coming from T.nagar who is a security by occupation belonging to socio economic class of lower middle came to op
CHIEF COMPLAINT
Swelling in the back of right shoulder for past 2 months
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HISTORY OF PRESENTING ILLNESS
The patient was apparently normal 2 months back after which he noticed swelling in the back of right shoulder
-duration 2 months
-insidious in onset
-progressive in nature
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-initially small in size now it attain present size
• No H/O pain, discharge
• No H/O ulceration, fungation
• No H/O trauma, fever
• No H/O evening rise of temperature
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• No H/O loss of weight, loss of appetite
• No H/O restriction of movement
• No H/O any other swelling elsewhere in the body
PAST HISTORY
• No H/O similar complaint in the past
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• No H/O previous surgery, hospitalisation
• No H/O DM, HT, TB, asthma, epilepsy, jaundice
• No H/O blood transfusion
PERSONAL HISTORY
• Consumes non-veg diet
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• Normal bowel and bladder habits
• Not a smoker
• Not a alcoholic
FAMILY HISTORY
• No relevant family history
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GENERAL EXAMINATION
• The patient is conscious, oriented, moderately built and moderately nourished.
• No pallor, no icterus, no cyanosis, no clubbing, no pedal edema, no generalised lymphadenopathy.
VITALS
• Pulse rate- 74/min normal in volume, regular in rhythm, no specific character, no radio-radial/radio-femoral delay, felt in all peripheral pulses.
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• Respiratory rate- 16/min, regular, thoracoabdominal type
• Blood pressure- 120/80mm of Hg measured in right upper arm in sitting posture
• Temperature-afebrile
LOCAL EXAMINATION
After getting consent from patient, after exposing adequately, the patient was examined under bright light.
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• Inspection
A single swelling approximately 3x4cm in size, ovoid shape present in the back of right shoulder.
Extent-superioly 4cm from acromian process
inferioly 7cm from acromian process
lateraly 4cm from pos.axillary fold
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medialy 7cm from midline
Surface - smooth
Skin over the swelling- normal with punctum
No scar, sinuses, dilated veins
No visible pulsation
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No visible lymphnode
Palpation
-not warm, not tender
-inspectory finding of size, shape and extent are confirmed.
-surface-smooth
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-margin-well defined, mobile
-consistency-soft
-skin over the swelling not pinchable
-non fluctuant
-non transilluminant
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-not compressible/reducible
-no pulsatile/expansile pulsation
-no lymphnode palpable
-neurovascular system-normal
SYSTEMIC EXAMINATION
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• Abdomen
soft, non tender, no organomegaly, no palpable mass, no free fluid, hernial orifice free, external genitalia normal
• Respiratory system
normal vesicular breath sound heard all the lung fields, no added sound
Cardiovascular system
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S1 S2 heard, no murmurs
• Central nervous system
no focal neurological deficit
• Spine and cranium- normal
DIAGNOSIS
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Sebaceous cyst in the back of right shoulder
INVESTIGATION
-complete hemogram- TC, DC, ESR, Hb%, BT, CT
-urine albumin, sugar, deposits
-blood sugar, urea
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-ECG (old patient)
-FNAC-to confirm diagnosis
TREATMENT
• Excision including skin adjuvant to punctum using elliptical incision(dissection method)
• Other method- incision and avulsion of cyst wall
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DIFFERENTIAL DIAGNOSIS
• Lipoma
• Dermoid cyst
| Sebaceous cyst | Lipoma | Dermoid cyst | |
|---|---|---|---|
| definition | Retention cyst, due to blockage of sebaceous duct and accumulation of secretion within gland | Benign tumour, arising from fat cell of adult type,. Universal tumour | This is cyst lined by squamous epithelium, containing desquamated cells, lies deep to the skin |
| site | Scalp, face, back, scrotum. Does not occur in palm and sole(absence of sebaceous gland) | Anywhere in the body except brain | Midline or line of the fusion, neck, post auricular, external angular, forehead |
| examination | Soft, smooth, punctum, well defined, skin over swelling not pinchable, fluctuation(-), transillumination(-), sign of moulding present | Soft, lobular, well defined, skin over swelling pinchable, pseudofluctuation, pseudotransillumination, slip sign(+), mobility(+) | Soft, smooth, well defined, skin over swelling pinchable fluctuation(+), transillumination(-) mobility(+), bony indentation present |
| Specific investigation | - | FNAC | FNAC and CT to rule out intra cranial extention |
| Treatment | Excision including skin adjuvant to punctum using elliptical incision, incision and avulsion of cyst wall, drainage and later excision | Excision | Excision of cyst |
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This download link is referred from the post: MBBS Final Year Case Presentation (Clinical Case Examination, Discussion and Treatment)