Large lump

Subcutaneous emphysema as a rare complication of pacemaker insertion

by Selwyn - 2017-10-22 10:48:24

This is where air has entered the tissues under the skin. Causes a soft swelling, worse with straining  ( perhaps from a very small pneumothorax).  If small, should subside by itself in a few days. 

Another possibility is a seroma- a collection of clear, plasma- type fluid. Not uncommon in surgical wounds. Also, resolves with time. 

As the problem seems to come in the upright position, I prefer to favour the bubble of air ( subcuteneous emphysema ) hypothesis.

CT scan should give the diagnosis. Ultrasound would show a seroma. 

Kind regards,

Selwyn

other possibilities...

by 0o0 DC 0o0 - 2017-10-23 07:08:40

Agree with and just to add to the above, if it is subcutaneous emphysema then from my experience you generally get a ‘crackling/bubbling’ kind of sensation if you put gentle pressure over the lump itself as you move the air around, not always but it is usually fairly easy to diagnose if this is the case.

Is it there immediately when you get up from lying down? When you say its soft, can you push into it and leave your finger indentations in it? If so, theoretically another alternative is a localised collection of fluid within the subcutaneous tissue such as oedema. Put simply, by having surgery you will have inevitably damaged blood vessels, this can compromise the blood flow to and from this region and cause fluid (not blood) to leak out of vessels causing a collection of fluid in the subcutaneous tissues. This can be generalised (large areas) or localised (small areas) depending on the location and degree of damage to the vessels.

A similar scenario can also occur with lymphatic vessel damage, resulting is a similar looking swelling but this time called lymphoedema, this can also be generalised or localised to a smaller area (although I have seen this less so on a localised basis). There is also collection of lymph nodes in the location you describe so equally these could be involved.

Generally, with either of those types (oedema/lympoedema) the swelling can get worse when you are stationary for a length of time but when gravity is acting against it (i.e. when you stand up) or when you move around the fluid disperses.

Another option (and it’s unlikely if it happened straight after your PM surgery but still a valid option) is that the swelling is entirely unrelated and may need further investigation to find out its cause.

I would get it further looked at anyway as I am sure you will if it doesn’t settle down soon and would sooner rather than later if it gets worse. I am not a doctor but for most of these differential diagnoses ultrasonic examination of the lump (whilst it is swollen) should shed light on the underlying cause or at least provide a suitable starting point. US waves do not penetrate air but equally if it is subcutaneous emphysema most ultrasonographers would be able to pick this up.

Large lump

by Booster - 2017-10-23 12:45:37

Thanks for the replies, by soft soft I mean you can push it and don't feel anything hard.  It does not leave a finger impression.

This morning a second lump about the size of a golf ball appeared on the other side on shoulder at neck.  This is the second time this has happened.

After 20 minutes the smaller is completely gone and the larger just barely there.  I do not feel or hear any crackling.

I'll give it a few more days and then give them a call.

Thanks again for the replies.