Movable Lumps in the Armpit: When Ultrasound Results Are Normal

There is a hard lump in the armpit, but the ultrasound results are normal?

Hello Doctor, about six months ago, while showering, I felt a movable hard lump at the lower edge of my armpit.
It's not superficial; I can only feel it when I apply some pressure.
A few days later, worried it might be a lymphatic tumor, I visited a hematology clinic.
The doctor performed a physical examination and mentioned that there seemed to be a small lump, but it should be benign.
Subsequently, I was scheduled for an X-ray and a chest ultrasound, both of which came back normal.
There were no signs of a fibrocystic mass or a fibroadenoma, which left me confused because I can clearly feel the lump, yet the chest ultrasound did not show it.
Is this a common occurrence? The hematologist suggested it was likely just a benign nodule and did not recommend further tests.
Now, six months later, the lump is still there, and I experience tenderness in the armpit about a week before my menstrual period, along with a sensation that the lump increases in size, but it returns to its original size (about 1 cm) afterward.
Should I seek further evaluation? If so, which specialty should I consult? Also, what do you think might be the underlying issue in my case? Thank you for your response, Doctor.

Wendy, 20~29 year old female. Ask Date: 2022/05/28

Dr. Yuan Tianmin reply Breast and Thyroid

Based on your description, it is more likely that you are experiencing what we refer to as accessory breast tissue, as accessory breast tissue is also composed of breast tissue and can be influenced by your menstrual cycle.
You may want to visit a breast specialty clinic for further examination.

Reply Date: 2022/05/28

More Info

When it comes to understanding movable lumps in the armpit, especially when ultrasound results are normal, it is essential to consider several factors. The presence of a movable lump that is palpable but not visible on imaging studies can indeed be perplexing. In your case, the lump you described, which is felt only upon pressure and is not visible externally, raises some important considerations.

Firstly, the fact that your ultrasound and X-ray results were normal is reassuring. These imaging modalities are typically effective in identifying solid masses, cysts, or other abnormalities in the breast and surrounding tissues. However, there are instances where certain conditions may not be easily detectable through imaging. For example, small benign nodules or lymph nodes can sometimes be missed, especially if they are not significantly enlarged or if they are located in areas that are difficult to visualize.

The lump you are experiencing could be a benign condition such as a lipoma (a benign fatty tumor), a lymph node that is reactive to hormonal changes, or even a fibrocystic change, which is common in women and can cause lumps that fluctuate in size and tenderness, particularly in relation to the menstrual cycle. The fact that you notice increased tenderness and size of the lump before your menstrual period suggests that hormonal fluctuations may be influencing the lump's behavior. This is not uncommon, as hormonal changes can lead to swelling of breast tissue and associated structures.

Given that the lump has persisted for six months and exhibits changes in size and tenderness, it is reasonable to consider further evaluation, especially if you have concerns about it. While the initial assessment by the hematology department indicated that it was likely benign, you might want to follow up with a specialist in breast health or a general surgeon who can perform a more thorough examination. They may consider additional imaging techniques, such as a targeted ultrasound or even a mammogram, depending on your age and risk factors. In some cases, a fine needle aspiration (FNA) or a core needle biopsy may be warranted to obtain a sample of the tissue for further analysis, especially if there is any change in the characteristics of the lump.

It is also important to monitor the lump for any changes in size, shape, or associated symptoms such as pain or changes in skin appearance over the area. If you notice any significant changes, it would be prudent to seek medical advice sooner rather than later.

In summary, while the normal ultrasound results are reassuring, your ongoing concerns about the lump, especially with its fluctuating nature, warrant further evaluation. Consulting with a breast health specialist or a general surgeon would be a good next step. They can provide a comprehensive assessment and determine if any additional tests or procedures are necessary to ensure your peace of mind and health. Always trust your instincts when it comes to your body, and don't hesitate to seek further evaluation if you feel it is necessary.

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