for a year i have notice a lump on my rib cage that just kept getting bigger. my fiance took me to the ER a few weeks ago to have it looked at and the doc there told me that he was just going to "slap a name on it and call it lipoma" after doing a single cat scan. he also told me to just go home and ignore it. this bothers me because he didnt seem to really care or try to help me with my problem. what test should i have done to make sure it really is lipoma? and what are your opinions on it?
Is This a Lipoma? The Dr. Told Me To Go Home and Ignore It. (photo)
Doctor Answers 4
Thank you for the question.
Given that the lesion is increasing in size and is obviously causing you anxiety ( enough to go to the emergency room and seek online consultation), you may want to have the lesion removed. This will be the only way to know for sure what the lesion is (pathologic evaluation).
You may want to be seen by her primary care physician who can refer you to the appropriate surgeon for evaluation and possible excision.
Is this a lipoma?
There are several points to be made in this situation. One is that It's not possible to diagnose a lesion below the skin with a photo or description and sometimes not even by exam. Another is that the ER is for emergencies and is not a good place for an evaluation and discussion of treatment options for non-acute problems. I should also be stressed that you can usually have something removed such as a benign mole just because you choose to remove it (and understand the trade-offs). "Insurance coverage" and "medical necessity" often get in the way of this. The best evaluation for removal of a possible lipoma or subcutaneous lesion is by a plastic surgeon who can handle non-insurance or non-medically necessary procedures and can do them for a reasonable cost in an office or outpatient clinic setting that minimizes costs that you will probably have to cover yourself.
One other consideration to keep in mind is the possible need for a biopsy if the lesion is not an obvious lipoma or cyst. A biopsy is considered a medically necessary procedure and more likely to be covered by medical insurance and if the biopsy shows some health-threatening type of lesion, then insurance should be involved although they will then dictate who you can see for the problem and where it can be treated.
"Is this lump that I am worried about a lipoma on my ribcage?"
Your question of is this a lipoma, is difficult to answer without the opportunity of doing an exam or reviewing the CT scan you had done, even with the picture you provided. Lipomas generally are not cancerous but are removed if they are bothersome or for definitive diagnosis. A primary care physician can usually help in identifying a lipoma, but a general surgeon is usually the doctor that will perform a removal. Watching it is often an option, but if it is growing, hurting or just worrisome, those are all reasonable reasons to proceed with removal. The emergency doctor you saw is not going to remove it and is likely focusing on making sure there is no life or limb threatening problem acutely but is not able to see you through all of what you need. If this is still a problem, I would encourage you to follow through on having it checked and diagnosed.
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lipomas can be diagnosed by physical exam and cat scans and ultrasounds or even a mri can be quite helpful for near definitive diagnosis though most would argue that most of these tests would be spending way too much money to definitively diagnose something so easily diagnosed by physical exam.
But the only way to know for sure is to take the mass out and send it for biopsy.
i agree with the other doctor who stated the E.R. is not the place to get non acute issues handled. the patient should go to either his primary care doctor if he is looking for a diagnosis or to a surgeon - general, plastic or even some dermatologists for definitive biopsy.
These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.