Download MBBS (Bachelor of Medicine and Bachelor of Surgery) Surgery Final Year Case Presentation Sebaceous Cyst Clinical Examination Discussion and Treatment
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 2months
HISTORY OF PRESENTING ILLNESS
The patient was apparently normal
2months back after which he noticed swelling
in the back of right shoulder
-duration 2months
-insidious in onset
-progressive in nature
-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
? 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
? 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
? Normal bowel and bladder habits
? Not a smoker
? Not a alcoholic
FAMILY HISTORY
? No relevant family history
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.
? 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.
? 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
medialy 7cm from midline
Surface ? smooth
Skin over the swelling- normal with punctum
No scar, sinuses, dilated veins
No visible pulsation
No visible lymphnode
? Palpation
-not warm, not tender
-inspectory finding of size, shape and extent
are confirmed.
-surface-smooth
-margin-well defined, mobile
-consistency-soft
-skin over the swelling not pinchable
-sign of moulding- present
-non fluctuant
-non transilluminant
-not compressible/reducible
-no pulsatile/expansile pulsation
-no lymphnode palpable
-neurovascular system-normal
SYSTEMIC EXAMINATION
? 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
S1 S2 heard, no murmurs
? Central nervous system
no focal neurological deficit
? Spine and cranium- normal
DIAGNOSIS
Sebaceous cyst in the back of right
shoulder
INVESTIGATION
-complete hemogram- TC, DC, ESR,
Hb%, BT, CT
-urine albumin, sugar, deposits
-blood sugar, urea
-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
DIFFERENTIAL DIAGNOSIS
? Lipoma
? Dermoid cyst
Sebaceous
Lipoma
Dermoid
cyst
cyst
definition
Retention cyst, due to Benign tumour,
This is cyst lined
blockage of sebaceous arising from fat
by squamous
duct and accumulation cell of adult type,. epithelium,
of secretion within
containing
gland
Universal tumour desquamated
cells, lies deep to
the skin
site
Scalp, face, back,
Anywhere in the
Midline or line of
scrotum.
body except brain the fusion, neck,
Does not occur in
post auricular,
palm and sole(absence
external angular,
of sebaceous gland)
forehead
On local
Soft, smooth,
Soft to firm, lobular, Soft, smooth, well
examination
punctum, well
well defined, skin
defined, skin over
defined, skin over
over swelling
swelling pinchable
swelling not
pinchable,
fluctuation(+),
pinchable,
pseudofluctuation,
transillumination(-)
fluctuation(-),
pseudotransillumina mobility(+), bony
transillumination(-), tion, slip sign(+),
indentation present
sign of moulding
mobility(+)
present
Specific
_
FNAC
FNAC and CT to
investigation
rule out intra
cranial extention
Treatment
Excision including
Excision
Excision of cyst
skin adjuvant to
punctum using
elliptical incision,
incision and avulsion
of cyst wall,
drainage and later
excision
This post was last modified on 08 August 2021