Armpit lump

Other names

Axillary lymph enlargement; lymph nodes enlargement; axillary abscess; localised lymphadenopathy

Definition

An armpit lump is an enlargement of one or additional lymph nodes beneath the arm.

Causes

• Lymphadenitis (enlarged lymph glands)
  Predisposing factors of lymphadenitis are trauma to the armpit area, obstruction of normal drainage, chemical irritation, haematoma (formation of a blood clot) and foreign bodies.  The process usually begins as a cellulitis (infection of the skin), which leads to necrosis (dead skin formation) and loculation of pus and the forming of an abscess, as well as lymphatic spread, also called lymphadenitis.
  

  Upon inspection, the area will appear red, tender, warm and swollen.  The patient can also be systemically ill and can present with symptoms of mild fever and malaise.
  You have to consult your doctor immediately to have the correct diagnosis made and to commence with the correct treatment.



• Cat scratch disease
  Three to five days after you have been scratched by a cat, red bumps will appear.  It will develop into non-itching papules and after three days it will turn into a crust that will heal with a scar.  Solitary lymphadenopathy (enlargement of lymph nodes) can be present in the affected area (armpit), three to four weeks after you have been scratched. These nodes can be painful, but will resolve spontaneously after two to four months.  A low grade fever, as well malaise and joint pain may be present.
  This can be treated at home with anti-inflammatories.  Contact your doctor if your symptoms worsen, in order to have a CSD skin test and to have possible antibiotics prescribed.


• Arm or breast infection
  This may present as swelling and redness of a part of the skin in the arm/breast area.  It will be tender and warm to the touch and may look like a lump.  You can treat this at home with topical antibiotic cream, as well as non-steroidal anti-inflammatories.  You should consult your doctor if the condition persists after five days or worsens.


• Hodgkin’s and Non-Hodgkin’s lymphoma
  These conditions are tumours of the immune system.  The diagnosis varies from Hodgkin’s and Non-Hodgkin’s disease.  There are different stages of the disease.  Stage one:  painless localised single lymph node in the cervical, armpit or neck area and may appear as a single lump.  Stage two:  more than one lymph node or group, but will be confined to one side of the diaphragm.  Stage three:  disease of lymph nodes or spleen occurring on both sides of diaphragm.  Stage 4: involves the liver and bone marrow.
  Symptoms are a high grade fever, as well as night sweat, malaise and weight loss. You should consult your doctor regarding treatment immediately.


• Leukaemia
  Leukaemia is a disease of the white blood cells in the body.  It may appear as a lump in the armpit when the disease has spread to the lymphatic system.  Other symptoms are malaise and anorexia.  Consult your physician regarding treatment.


• Sporotichosis
  This is a fungal infection that affects the lymph nodes and other systems (lungs) and that will cause painless lumps, especially on the skin (below the armpit), feet and hands.  It is caused by the inhalation of dust carrying these fungi.
  Should you suspect that you have been infected, contact your doctor immediately regarding treatment.


• Benign (harmless ) cyst
  A cyst is an abnormal closed membranous cavity containing fluid or semi-solid material.  It is usually well encapsulated and is rarely painful.  Cysts can become secondarily infected and cause a painful red lump beneath the skin.  Do not squeeze the lump, as it may spread and cause cellulitis (skin infection).
  You should not try to treat this at home.  Consult a doctor to surgically excise the cyst to prevent reoccurrence. 


• Lipomas
  A lipoma is a benign, slow-growing, fatty tumour which is lobulated.  It is a soft, mobile” lump” beneath the overlying skin and is most commonly on the neck, armpit and trunk.  The size is usually less than 6cm and it is rarely painful.  The peak occurrence is in the fifth or sixth decade of life.
  Surgical excision is necessary to remove the lipoma and to ensure that it does not have any cosmetic effect.


• Normal breast tissue
  Sometimes normal breast tissue appears in the armpit.  This is benign (harmless) and can be surgically removed for cosmetic reasons.


• Allergic drug reaction
  This will cause itchy, red, inflamed lumps/hives in the neck and the rest of the body.  Drug allergies are normally caused by drugs such as penicillin and aspirin.
  It can be treated at home with antihistamines and a topical cream like Anthisan.  If symptoms are accompanied by shortness of breath, you should contact your doctor immediately.


• Measles
  Measles is a negative-sense, enveloped paramyxovirus infection spread by respiratory droplets.  It enters the respiratory system and spreads to the lymph nodes. Lumps may therefore occur below the armpits.  The incubation period is seven to twelve days.  It is contagious four days before the rash appears.  Symptoms are a cough, conjunctivitis (redness of the eyes), a high fever, photophobia and malaise.  There will be an increase in severity until three to four days prior to the rash.  It spontaneously resolves within seven to ten days after the rash appears.
  Measles will be treated with bed rest, adequate hydration, Vitamin A supplements and anti-inflammatories, but you should still consult your doctor, in order for him/her to make a proper diagnosis.  If you are pregnant, you should immediately consult your physician.


• Mumps
  The incubation period of mumps is 14 – 24 days; symptoms include fever, general body pain (especially neck) and malaise.  The classic presentation is pain and swelling in one or both parotid glands and you will have a moderate fever.  Mumps peak in the first three days and will subside within three to seven days.  The submandibular glands are often also involved and it will appear as big lumps just below the jaw line or below the armpits. Occasionally you will have a rash on your trunk.
  Treatment at home will be bed rest and adjusting your diet if you have problems with chewing.  If you experience severe body pain/joint pain, you should consult your doctor. He/she will probably prescribe a two-week course of corticosteroids.  If you have inflammation of the testis in conjunction with the mumps, you should wear tight underwear and get enough bed rest (as much as possible).


• Rubella, smallpox and typhoid vaccinations


• Aids (Acquired Immune Deficiency Syndrome)
  This is the final and most severe stage of the HIV disease and causes serious damage to the immune system.  Someone is diagnosed with Aids when a person with HIV has a CD4 count less than 200.  CD4 cells are a type of immune cell that are also called “helper cells” (T-cells).
  Aids also affects the lymph nodes which causes lymphadenopathy (enlargement of the lymph nodes), especially under the armpit. These are non-tender lumps.


• Chickenpox (Varicella)
  Chickenpox is a Varicella-Zoster virus infection, which spreads by means of respiratory droplets and contact with the blisters.   It enters the respiratory system and spreads to the lymph nodes; hence lumps may appear underneath the armpits.  The Varicella-Zoster virus can lie dormant in the body and lead to Herpes Zoster (shingles) at a later stage.
  Symptoms include malaise, low grade fever, abdominal pain, a sore throat and a rash.  The rash consists of small, red spots.  It rapidly progresses to papules and then vesicles (blisters) and eventually crusts.  It is infectious one to two days prior to the rash up to four to five days after the rash has disappeared.  There is a risk of secondary bacterial infection that causes cellulitis (skin infection), sepsis and Varicella pneumonia (especially in adults).  If this occurs, you should be treated by a physician immediately.
  Chickenpox can be treated at home with oatmeal baths, calamine lotion and oral antihistamines.  Panado can be taken for pain and fever.  In severe cases, consult your physician, to get a prescription for acyclovir.


• Infectious mononucleosis
  This is a clinical syndrome typically characterised by fever, pharyngitis, lymphadenopathy (enlarged lymph nodes in the armpit) and atypical lymphocytosis (general infection of the lymph nodes).  It is most commonly caused by the Epstein - Barr virus.  It is usually diagnosed in patients younger than 35 who have initial symptoms of malaise, fatigue, low grade fever and painful joints for three to seven days.
  You should consult your doctor immediately, in order to have a mono-spot test done.  In less severe cases, it will be treated with analgesics and bed rest.


• Herpes Zoster (Shingles)
  Shingles is a latent reaction of chicken pox.  This virus lies dormant in the dorsal ganglia until it is reactivated by stress, trauma, medication and other possible systemic infections.  The rash is confined to a specific dermatoma on the face/neck.  It can therefore, appear anywhere on the face/neck.  This condition is extremely painful and cause systemic effects, such as malaise, fever and general sweating.  Shingles can also cause enlarged lymph nodes in the neck and the armpit, which will present as a lump.
  You should consult your doctor for treatment.  He will prescribe tricyclic, as well as anti-viral therapy that includes topical anti-viral cream and acyclovir orally.

Written by Dr Anrich Burger, MB ChB (Stell)