2 Lipomas and a Pterygium

by chelseajin

Talk about being common. We started off the day seeing a man who said he was worried about a lump on his back. It had appeared mysteriously and was pretty sizable. We hadn’t even seen the patient yet and I was thinking maybe this was a lipoma, but I thought nothing of it.

We go in, lo and behold, we can pinch off the entire lump and it really does seem to be a lipoma. It’s probably the best lump you can walk into the doctor’s office with– although explaining in Spanish that it’s a benign tumor is always scary for the patient. They hear “tumor” and you start seeing a sympathetic reaction– whites of eyes, blood pumping, heart thumping, sitting straight up– right away.

Looks a lot like our patient’s, but a little higher up.

Towards the end of clinic, we have a straggler come in. He’s a young Hispanic who’s clearly anxious. We find him on the stool for the doctors, but it’s no big deal, and the resident starts to ask him some questions.

In a strange way, it’s almost a blessing to have a patient who is in real distress. They won’t pussyfoot around the issue and try to give you superfluous information, they just yell at you their chief complaint. This guy blurted out that he was worried about this lump on his right hip. The resident and I were being pretty laid back about it, just wanting to get the whole picture, but he kept bringing it up and so we got him on the exam chair and started to examine him.

I feel like he knew someone with a strangulated hernia, because he was afraid that’s what he had. It most definitely wasn’t. Although he reported a little pain, the lump was just like the lipoma was saw before. We could feel around all the “edges” and squeezing it didn’t elicit much pain. It was also right on top of his hip bone, which isn’t where a hernia would show up.

The poor guy was in tears from the anxiety, he was convinced he was going to the hospital. After some more Spanish finagling– but I think saying “Muchas personas tiene eso, es muy comun. Es solo una bola de grasa” (A lot of people have this, it’s very common, it’s only a ball of fat/grease) was ok. He seemed to be relieved. But there’s not much you can do about it except leave it and for someone without insurance, excising it is almost a waste.

The next issue was his eye. I’m sure the resident and I had seen it right off the bat, he had some sort of growth or worm-like thing in his left eye, just interrupting the iris.

It reminded me of Prometheus” Alien precursors. He described it as a “carnosidad“. I can’t help but get excited that there’s something new, a parasite! Finally! I look it up quickly on my phone, but it’s a Spanish word, not Latin, and it directs me to a “pterigion”, which somehow also is Spanish. But it doesn’t look like a parasite– hopes dashed.

I pop out for a second to ask Betty what she thinks from my description of it and she nails it– a Pterygium, an overgrowth of the conjunctiva due to excessive dryness/dust/UV exposure. The resident agrees. She does a quick eye exam to see if it’s obscuring his vision, but he does pretty well on both eyes. So what can he do he asks. Keep his eyes protected from the sun, keep them hydrated from drops, if his vision starts to deteriorate, then he’ll have to go to Mexico to see an ophthalmologist to think about surgery.

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