What Does Lump Under The Ribcage After An Acctidental Fall,indicate?

Posted on Tue, 28 Jan 2014

Medically reviewed by Ask A Doctor - 24x7 Medical Review Team

Tue, 28 Jan 2014 Answered on

Sat, 15 Feb 2014 Last reviewed on

Question : I took a bad fall on the ice about 2 weeks ago and hit my head. But I think the fall did something to my abdomen and maybe I twisted something. In the meantime, I have had this constant cough that seems like it either tore or really strained my abdomen muscles so that they hurt. I now have this soft lump (egg size) on my left side right under my rib cage. What do you think?

Answered by Dr. Dr. Prasad J (5 hours later)

Brief Answer: Need clarifications... Detailed Answer: Hi, Blunt trauma is hard to evaluate without a clinical examination. The lump that you feel may be a hematoma collection or something unrelated to the fall. I would need lot for help from you to be able to understand it. So can you answer some of my questions: 1. Is this a diffuse lump or are you able to mark the borders of the lump out? 2. Is it tender to touch? If it is not tender what is the feel of the lump (consistency) - is it soft like sponge or firm as muscle or bony hard? 3. Do you notice any skin changes over and around the lump? 4. Again if it is not tender, are you able to move the lump around or may be even push it back into the abdomen? 5. The strained abdomen that you feel while coughing, is it felt in the same area? Awaiting your reply... Regards

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Dr. Prasad J (8 hours later)

Hi Doctor, 1. This is not a diffuse lump. I can mark the borders of the lump. 2. It's a little tender to the touch and has a low level of pain, but bothersome so that I don't want to strain it in anyway but the stomach muscles below it feel like they've been strained and when I cough my whole left side of my abdomen hurts. Sometimes, I try and hold my stomach and bend over when I know a sneeze and cough are coming on. It is 'soft like a sponge', certainly not bony hard and not firm. 3. No skin changes over and around the lump, no discoloration. It looks kind of like a lump of fat. 4. I cannot move the lump around at all. I cannot push it back into the abdomen. It is not a movable lump. It's soft and almost 3 inches wide and you can see the bottom of this 'lump' but you cannot really see the 'top' of where it begins. Just looks like a 'bulge' almost fatty-like. 5. The strained abdomen when I'm coughing is also felt on the lump. The pain is sharper in the abdomen muscles below it, like a stabbing pain. And when I stretch (I try not to), I feel my abdomen muscles have been strained and it seems like the culmination is in the lump. When I'm sitting down and typing there is a 'throbbing' feel. Not acute pain. Although, when I first got this and my cold and cough started - there was acute pain all through the left side of my abdomen almost down to the bottom of my abdomen by the naval. Hope this helps! Thanks.

Answered by Dr. Dr. Prasad J (11 hours later)

Brief Answer: Muscle strain vs internal injury... Detailed Answer: Hi, Thanks for providing additional details. There are 2 conditions that I could think of based on your description. 1. Muscle strain is definitely the first possibility. Inflammation from a strained muscle appear swollen. The size of swelling is proportional to amount of inflammation. It is possible that part of muscle surround the lower chest and upper abdomen was injured and resulted in swollen muscle. Occasionally inflammatory fluid that ooze into the subcutaneous tissue may also result in swelling. It would take rest and some antinflammatory medicines to heal it. Average healing time would be around 2-4 weeks. 2. Second possibility is that of internal injury. The area that you mentioned (left under ribs) is where your spleen is located. Further since the swelling appears under ribs (top margin not defined while rest of the area is demarked) raises my suspicion about spleen enlargement. I would order for an ultrasound check in the first instant to exclude splenic enlargement. Besides these two other causes of this swelling is unrelated to injuries. Therefore I think your condition warrants a visit to your doctor. A detailed examination under broad light and ultrasound examination of the affected area is recommended. In the meanwhile use ice alternating with heat for symptomatic treatment. Hope this helps. Let me know if you need clarifications. Regards

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Dr. Prasad J (23 hours later)

Thank you for your response. I was hoping that the explanation for this would be your answer of muscle strain and inflammation. I will see my doctor in the next few weeks and see what happens then and also mention your suggestion of having something to do with the spleen. I hope this is not the case but I will certainly check it out. In the meantime, I have been taking an over-the-counter anti-inflammatory. At the beginning, I was icing it but have stopped that. Would it be possible to exercise in the meantime? As in weights for the arms and legs? Not doing anything with the stomach, such as sit-ups. Just some low-level exercise to keep somewhat in shape?? Thanks!

Answered by Dr. Dr. Prasad J (2 hours later)

Brief Answer: Better to avoid exercise... Detailed Answer: Well, the possibility of muscle strain and inflammation is most likely; given the fact that spleen injuries are far less common from a fall injury. I would continue to use pain killer only when required. Any form of physical exercise delay muscle strain healing. Therefore if it isn't really necessary you can avoid those exercise. You can reconsider it after you consult the doctor. Watch out for pain worsening, increase in the size of lump, skin color changes, weakness and dizziness. You should seek medical help soon as and when needed. Wish you a speedy recovery... Regards

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar