Download MBBS (Bachelor of Medicine and Bachelor of Surgery) 4th Year (Final Year) Types of Swelling Notes Handwritten Notes
Types of swelling
? According to the cause
? - Congenital
? - Traumatic
? - Inflammatory
? - Neoplastic
CONGENITAL SWELLINGS
? DERMOID :This cyst general y develops in the line
of embryonic fusion. So this cyst may appear
anywhere in the midline of the body as also in
places where the two embryonic processes meet
each other e.g. at the outer angle of the orbit
(where the fronto-nasal process and the maxil ary
process fuse with each other), behind the pinna
(Post auricular dermoid), just below the tongue in
the midline (Sub-lingual dermoid) etc.
? Implantation or acquired dermoid
? It is not a congenital swel ing in the true
sense, but it is described here as it is included
in the category of the dermoid cyst.
? It is actually a traumatic swelling and results
from the surface ectoderm being driven into
the subjacent tissue.
HAEMANGIOMAS
These are vascular malformations or
hamartomas and may arise from the capillary
or the vein or the artery and accordingly called
a capillary haemangioma or cavernous
haemangioma or a plexiform (cirsoid)
haemangioma respectively
1.Strawberry Naevus;
2. Port-wine stain, which is a collection of dilated intradermal capil aries.
3. Spider Naevus, in which there are visible radiating branches
from a single arteriole.
? Capil ary Haemangiomas -- are bright red or purple coloured
patches of varying sizes. These are general y flat and not much
raised above the skin surface. Pressure may cause complete
disappearance or diminution of the colour which returns
immediately when the pressure is released.Important varieties are:
? (i) Port-wine stain is a diffuse telangiectasia
? (ii) Salmon patch is usual y present since birth and often seen in
the forehead or on the occiput. It usual y disappears before first
birthday.
? (ii ) Spider Naevus has a central red spot with numerous radiating
fine blood vessels like the legs of a spider. It is mostly seen on the
upper half of the trunk, face and arms. These fade completely when
compressed with the finger refil as soon as the pressure is released
? Cavernous hamangioma:
? Cavernous Haemangioma is a bigger
haemangioma than the cappilary one . It
consists of dilated spaces containing blood
and gives rise to soft spongy bluish swelling,
which is compressible and can be emptied by
pressure but reappears on release of pressure.
Common occurrence is seen in the lips,
cheeks, face, brain, etc.
Congenital arteriovenous fistula
? It is the result of persistence of congenital
communication between the arteries and veins
affecting the extremities usual y. The diagnosis is
made by warm limb, enlargement of the limb,
localized bruit over the fistula, presence of
varicose veins and insufficiency of the distal
circulation.
? Acquired arteriovenous fistula may appear
fol owing trauma or may be created surgical y for
haemodialysis.
traumatic
? Traumatic swellings arising from the skin and
subcutaneous tissues are rare.
? Haematoma following a trauma may give rise
to swelling
? Acquired Dermoid cyst
INFLAMMATORY
? ERYSIPELAS.-- It is a spreading cuticular
lymphangitis which may fol ow even a
scratch. The causative organism is mostly Str.
Pyogenes. The conditions which predispose
this disease are debilitating state and poor
health of the patient. The condition
commences as a rose-pink rash which extends
to the adjacent skin. The vesicles appear
sooner or later over the rash and rupture
? CELLULITIS
? It is a spreading inflammation of the
subcutaneous and fascial tissues leading to
suppuration, sloughing or even gangrene
(especial y in cases of diabetes) of the affected
part.
? The commonest organism is again Streptococcus
pyogenes. The organisms gain access through an
accidental wound, however trivial it may be.
? The victims are general y diabetic or debilitated
individuals with poor nutrition.
? The affected part becomes swollen, hot and
tender. The condition starts with redness,
itching and stiffness at the site of inoculation.
The part gradually looks brawny and becomes
oedematous which is demonstrated by pitting
on pressure.
ABSCESS.-- An abscess is a col ection of pus
within the body.
? Pyogenic Abscess.-- This is the commonest
variety of abscess and may result from cel ulitis
or acute lymphadenitis.
? The organisms gain entry either directly through
the penetrating wound or local extension from
adjacent focus of infection or haematogenous or
lymphatic spread from a distance.
? Cold Abscess.--this abscess is cold and non-
reacting in nature.It does not produce hot and
painful abscess as seen in pyogenic abscess.
Brawny induration, oedema and tenderness are
conspicuous by their absence.
? Cold abscess is almost always a sequel of
tubercular infection anywhere in the body
commonly in the lymph nodes and bone.
? Caseation of the lymph nodes forms the cold
abscess. The commonest sites are at the neck and
axil a
? BOIL (Furuncle).-- Infection of a hair fol icle
with Staphylococcus aureus leads to this
condition.
? It may be associated with perifolliculitis,
which may proceed to suppuration.
? It starts with a painful and indurated swelling
which gradually extends. There will be
tremendous tenderness with surrounding
oedema.
? CARBUNCLE.-- It is a bigger form of boil and the
causative organism is again Staphylococcus
aureus.
? This is due to infective gangrene of the
subcutaneous tissue where the infection has
already spread.
? General y men above 40 years of age are
sufferers and they aremostly diabetic.
? Carbuncles are commonly seen on the back, in
the nape of the neck where the skin is coarse and
the vitality of the tissue is less.
NEOPLASTIC SWELLINGS
? BENIGN NEOPLASMS :
? PAPILLOMA.-- This is a simple overgrowth of
all layers of the skin.
? Mostly it is a pedunculated growth having
branched villous processes.
? It consists of a central axis of connective
tissue, blood vessels and lymphatics.
? FIBROMA.--
? This is a tumour of the fibrous tissue.
? Most fibromas are combined with other
mesodermal tissues, such as fat (Fibrolipoma),
the muscles (Fibromyoma), nerve sheath
(Neurofibroma) etc.
? Neurofibroma may be seen in multiple
numbers, which is called Neurofibromatosis
(Von Recklinghausen's disease)
? LIPOMA.-- A lipoma is a cluster of fat cells which become
overactive and so distended with fat that it produces a
palpable swelling.
? This is the commonest tumour of the subcutaneous tissue.
? It may occur anywhere in the body, hence it is known as
'universal tumour', but mostly seen in the back of the neck,
shoulder and the back.
? The edge is definite and slips under the palpating finger,
which is known as `slip sign'.
? This sign is helpful to differentiate this condition from a
cyst in which case the edge does not slip away from the
palpating finger, but yields to it. Consistency is soft but
does not fluctuate.
? MOLES (pigmented naevus, freckles, benign
melanoma).--
? 'Naevus' means a lesion which is present since
birth.
? Although many of these may be present since
birth, yet others appear later in life. This lesion
contains an excess quantity of melanin,
derived from melanocytes.
malignant
? BASAL CELL CARCINOMA (Rodent ulcer).-- This
tumour of low-grade malignancy is common in
white-skinned people.
? 90% of this tumour is found in the upper part of
the face above the line drawn from the angle of
the mouth to the lobule of the ear, the
commonest site being inner or outer canthus of
the eye
? It starts as a brownish nodule and later on
becomes ulcerated with a wel defined hard and
raised edge with a beaded appearance.
? This characteristic feature of eroding the
tissues, which come in contact with it, has
given it the name `rodent'.
? Dissemination by lymphatic or blood vessels
does not occur. So the regional lymph nodes
are not enlarged and there will be no
metastasis to the distant organs.
? SQUAMOUS CELL CARCINOMA (syn.
Epidermoid carcinoma or epithelioma).--
? These are previously irradiated skin, a long
standing ulcer e.g. varicose ulcer, scar from a
burn (Marjolin's ulcer), repeated irritation of
the skin by various chemicals such as dyes, tar
etc. and a few premalignant conditions such
as Bowen's disease, Leukoplakia, Paget's
disease etc.
? This tumour originates from prickle cell layer
of the skin. It may give rise to sessile
cauliflower mass or fungating ulcer with
raised and everted margin. The base is
always indurated and hard as also the edge.
? The regional lymph nodes are often involved
as lymphatic spread is quite common and
takes place early.
? MALIGNANT MELANOMA.-- It is a malignant
tumour of melanocytes, which originate from the
neural crest and so ectodermal in origin. It may
occur de novo or in a benign mole.
? Melanocytes are stimulated by ultraviolet light.
? A halo of brown pigment may be seen in the skin
around the tumour which indicates local
infiltration of the tumour.
? Satel ite nodules may be seen in the skin and
subcutaneous tissue between the primary
tumour and the nearest regional lymph nodes.
? This is due to lymphatic spread of the tumour
by embolism which stops in the wall of the
lymphatic and starts growing. These nodules
are often hard in consistency.
? Malignant melanoma also metastasises
through blood stream to the liver, lungs,
bones and brain.
? SARCOMA.--This is a malignant tumour of
connective tissue. It may occur from any
structure derived from mesoblastic origin.
? In contradistinction to the carcinomas, the
sarcomas usually affect younger age group.
? These are rapid growing tumours and
disseminate mainly by the blood stream
hyperkeratosis
? WARTS.-- These are patches of overgrown
skin with hyperkeratosis.
? Kiss lesions may appear in the skin where they
frequently come into contact with warts.
? This condition frequently affects the hands,
the face, the knees, the sole of the feet
(plantar warts) and axilla.
? KELOID and HYPERTROPHIC SCAR.-- This is not a
tumour but an overgrowth of the fibrous tissue
which is concerned in wound healing and
strengthening of the wound.
? In abnormal cases there may be an excessive
amount of fibrous tissue in the scar, which is
cal ed hypertrophic scar.
? In contradistinction to the hypertrophicscar, in a
keloid the fibrous tissue extends beyond the
original wound.
This post was last modified on 11 August 2021