Expert: Dr. J. Shawn Leatherman - 1/3/2008

Question
Hi, my problem seems to stem from a lump which can be felt very easily in my left breast. I am 21years old and discovered the lump last year and upon seeking medical advice the doctors initial reaction was to refer me to a breast clinic for a scan. However with the lumps nature being rock hard and bone like, accompanied by the fact that I cant bend without pain or lift anything as heavy as a shopping bag without pain, followed by slight breathlessness..I imagined it was more likely to be an injury of the ribs. The scan showed there was no trace of a lump in the tissue but revealed an arch in one of my left ribs around this area. I was then sent for an Xray after which I visited a and e a week later because of serious breathlessness. The doctor in A and E told me she viewed my x ray and there was no problem..I am doubtful. I never heard any more word on the x ray. A year later the lump is so big it is almost visible through the top of the breast, my partner also feels my entire chest area looks twisted. I keep suffering from mysterious 'infections' every few weeks, the symptoms are pain in chest area, extreme nausea..sometimes vomiting, high temperature and sweats. I've always been told by any doctor that these are chest infections..however I've never had a cough and suffer from these 'infections' regularly. Could this be the result of inflammation? Neglected injury? Every doctor I have seen has asked me was I in a serious car accident or what happened? I don't know the answer to this other than I worked weekends in a kids indoor playground, I sat in a cramped, hunched position at the top of a slide for hours. One doctor through feeling the area a year ago said my ribs were arched like knuckles and the only thing he could advise would be injecting steroids into the area. Lately a Chinese doctor felt the area and said my breathing wasn't up to standard and there was bruising around the ribs. I am currently awaiting an appointment with my local doctor, it has been a year since I attended but the pain is becoming unbearable and I keep getting sick. Do you have any idea what could be causing this???

Answer
Dear Fiona,

I cannot give you an accurate opinion on what the problem is because there are many things to consider.  This issue can be related to a metabolic dysfunction/disease, chronic inflammatory response, autoimmune conditions, abnormal trauma response after earlier injury, or tumor (benign or malignant).  There are a multitude of possibilities.  This is definitely not a chiropractic issue, and you need to follow the medical route concerning the primary diagnosis.

The fact that this condition has been ongoing and is progressive is a red flag.  Your doctors should be diligently hunting down the cause of the problem rather than just suggesting steroid injections.  I am not sure of the completeness of their examinations, but at the bare minimum you need to have comprehensive blood panels, new x-rays or a CT scan, and a complete physical examination.  A bone scan is also an option to see if there are more active sites in the body, but it will only show active metabolic processes of the bone, it will not specify what the process is.

I know that you said a previous physician stated that it was not in the soft tissue, only the bone, but this needs to be further confirmed due to the expansive growth, continued infections, and pain.  It could be both a bone and soft tissue issue... but I doubt that there is any lung involvement due to the superficial location of the lump (close to the skin).  Anything that is expanding tissue means that the area is growing and has a tumor like quality, whether metabolic, infectious, or malignant, it must be classified and understood to determine the best course of action.

I would further suggest that you make sure that a radiologist reads and reports on all of your imaging studies, not your family physician.  Most primary care physicians are not sufficiently trained in the interpretation of diagnostic imaging.  Once the information about labs and imaging studies has been interpreted, a possible biopsy of tissue would be the next step.  This should be analyzed by a pathologist to determine the quality of the tissue as well as the distinctive cell types within...this will be the most specific way to determine the extent of the issue.  All of the above information will determine the need for any pharmaceutical remediation or surgical correction, as well as any possible need for oncology (cancerous treatment).

Lastly, the key point is to make sure that the doctors you are seeing are actually performing their due diligence.  If they don't know the answer, then they need to look deeper, or refer you to a more qualified physician. Do not let them tell you nothing is wrong and blow you off.  This condition is obviously progressive and needs to be identified.

Hope this helps Fiona, goo luck!

Respectfully,
Dr. J. Shawn Leatherman
www.suncoasthealthcare.net