From the Guidelines
Bilateral axillary lumps should be evaluated with a thorough history and physical examination, followed by imaging with ultrasound of the axilla as the initial step, as recommended by the most recent guidelines 1. The differential diagnosis of bilateral axillary masses is broad and includes normal variants, infectious or nonmalignant etiologies, and malignancies.
- Key considerations in the evaluation include:
- Determining the characteristics and associated symptoms of the lumps
- Checking for fever, weight loss, night sweats, and examining other lymph node regions
- Diagnostic testing with complete blood count, inflammatory markers, and imaging such as ultrasound or mammography
- Fine needle aspiration or excisional biopsy may be necessary for definitive diagnosis
- Treatment depends on the underlying cause, with options including:
- Antibiotics for bacterial infections
- Observation for viral causes
- Referral to oncology for suspected malignancy
- The bilateral presentation of axillary lumps often suggests systemic causes rather than localized problems, and patients should be advised to seek prompt medical attention if lumps persist beyond 2-4 weeks, grow rapidly, or are accompanied by constitutional symptoms, as these features increase concern for malignancy 1.
- The use of ultrasound as the initial imaging modality is supported by recent guidelines, which recommend it as the first step in evaluating bilateral axillary lumps 1.
From the Research
Evaluation Approach for Bilateral Axillary Lumps
- The evaluation of bilateral axillary lumps typically involves a combination of physical examination, imaging studies, and laboratory tests to determine the underlying cause.
- There is no direct evidence from the provided studies 2, 3, 4, 5, 6 that specifically addresses the evaluation and treatment approach for bilateral axillary lumps.
Laboratory Tests
- Laboratory tests such as complete blood counts, blood chemistry tests, and inflammatory marker tests may be ordered to help diagnose the underlying cause of the axillary lumps.
- However, the provided studies primarily focus on the properties, indications, and usage of antibiotics such as amoxicillin and clavulanic acid 3, 4, 5, 6, and do not provide direct guidance on the evaluation of bilateral axillary lumps.
Imaging Studies
- Imaging studies such as ultrasound, computed tomography (CT) scans, or magnetic resonance imaging (MRI) scans may be used to further evaluate the axillary lumps and determine their composition and extent.
- Unfortunately, the provided studies do not discuss the use of imaging studies in the evaluation of bilateral axillary lumps.
Treatment Approach
- The treatment approach for bilateral axillary lumps depends on the underlying cause, which may include infections, inflammatory conditions, or other diseases.
- While the provided studies discuss the use of antibiotics such as amoxicillin and clavulanic acid in the treatment of various infections 2, 3, 5, they do not provide specific guidance on the treatment of bilateral axillary lumps.