Looking for a cyst

Claudia is back and the pain is worse. She’s done everything I’ve asked but the problem is getting worse.

It was about a week ago when she showed up with her son, Christopher, complaining of pain under the left breast. I checked there area and it was a bit perplexing. There was tenderness, but I could not feel anything abnormal – no telltale bogginess to suggest a fluid collection. Yet my suspicion remained – there could be an abscess or cyst under there. But I don’t want to go in there with a scalpel without knowing what I’m going to find.

So I sent her to ultrasound. I was pleased to get a personal call from Dr. V., letting me know that there was a fluid collection, and that it was likely a sebaceous cyst. It was only 1 centimeter in size, so not extensive in size.

Now back in the exam room, I had Claudia get back on the exam table. Once again I felt for any telltale localizing signs to help me know where to cut. There was not much there to guide me. I got out the syringe with anesthetic and begain to inject a little of it. But this was destroying what little telltale signs there were. Then the area was cleansed with iodine, making ever larger circles with the brown colored swabs until the are was painted about 6 inches across. With scalpel in hand, I chose and area and began to cut into the skin. It did not feel like the right spot. The skin was too firm, too normal. I felt the skin again with my gloved hand, trying to detect the telltale flexibility in the skin. There, just a centimeter to the left, it was a little different. Again I took the scalpel and cut in, looking at her face to detect whether the anesthetic was working. No pus or liquid was detected. I cut alonger incision, now 1 -2 cm long and gradually began to dissect the skin to the side. Suddenly, the telltale white, cheesy liquid bubbled to the surface. I was in the cyst. Paydirt! ‘

Opening the incision a little more I began to explore the cyst cavity. Large amounts of purulent smelly marterial bagan to extrude and trickle down her left side. I pushed the curved hemostat into the wound, exploring it’s limits. The cyst extended along the muscular chest wall about 1 inch in each direction, forming a large flat cystic structure.

Then, taking the syringe, I injected saline solution to cleanse the wound until fragments of the cheesy material stopped rising to the surface. I then pushed a long piece of gauze into the wound, taking care to fill all the empty spaces. I trimmed it close to the opening of the wound.

Claudia looked exhausted and painful, but relieved. I gave her a prescription for an antibiotic, and asked her to return in a few days. Her husband will withdraw the drain little by little until I see her.