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Case Presentation(swelling fore arm in a child)
Department of Paediatric Surgery
Civil Hospital Karachi
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BIODATA
Six months old baby girl, residentof Jacobabad, came to the OutPatient Department of Paediatricsurgery with!
Presenting complaint of:swelling on Left Forearm since 5
months.
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H.O.P.C.
According to her mother she wasalright 5 months back then hermother noticed a small red/purple
colored nodule which was graduallyincreased in size and during 5month period it reached up to thesize of 5x5 cm, initially they visitedGPs of local area but didnt getbenefit, then they decided to goCivil Hospital Karachi.
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History Past History: no significant past
Medical or Surgical history.
Family History: only child of herparents. No family history of suchtype of disease.
Personal History: her sleep andfeeding habits are regular.
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History Birth History:no antenatal visits of
her mother, delivered at home bydai, no significant post natalhistory.
she is on mother feed.
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Examination 5x5 cm swelling on anteriolateral
surface left upper forearm just belowthe elbow joint, swelling is soft to firm,
non-tender,temperature is not raised,its floor is ulceratedand its marginsturned to red/purple color and areirregular, it is not
reducible/compressible, having nopulsation or bruit. No distalNeurovascular deficit.
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DIAGNOSIS ?
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hemangioma
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Hemangiomas
Hemangiomas, comprisingapproximately 7% of all benign softtissue tumors .
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Development
The hemangioma is a true vasculartumor that results from a overgrowthof normal vascular tissue .
It exhibits relatively rapid earlygrowth until approximately 6 to 8months of age (proliferative phase),followed by regression by 5 to 9 yearsof age(involutory phase).
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Development
The majority of the Hemangiomas ininfants are noted by the parent withinthe first month of life.
Hemangiomas are initially noticed as anerythematous, macular patch, whichprogresses through a rapid proliferative
phase whereby it changes its color andgrows faster than the commensurategrowth of the child.
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Clinical presentation
By the time the patient is 12months of age most Hemangiomashave shown of involution. Theprocess of involution is normallyslow and will not be completed untilthe age of 5 to 9 years.
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Clinical presentation
Hemangiomas are found in thesuperficial tissue, the deep tissue,or both and may affect organ
systems such as the liver, lung,spleen, and gastrointestinal tract.
Most superficial Hemangiomas canbe diagnosed by clinical examinationand a detailed and accurate history.
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Clinical presentation
Deep Hemangiomas involve muscleor visceral organs and, are moredifficult to diagnose. Therefore,
further diagnostic studies arerequired. Intra-osseousHemangiomas are extremely rare.
The predilection for females isapproximately a 3 :1 ratio.
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Investigations
Ultrasound
Computed tomography (C. T .Scan)
and Magnetic resonance imaging (M. R. I) imaging techniques are usedas diagnostic aids to document the
extent of the deep Hemangiomas.
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Arteriography is rarely indicatedfor the diagnosis of a Hemangiomas.
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Management
Observation and parental support arethe initial approaches in the managementof maxillofacial Hemangiomas.
If functional compromise such as visualchange, airway or masticatory
compromise, bleeding, ulceration, orinfection occurs intervention isnecessary.
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Management
Wait & watch- many small haemangiomas involutespontaniously.
This may initially involve cortico-steroids for rapidlyproliferating lesions or therapy with interferon alfa-2a.Corticosteroids can be given locally or in case of
extensive haemangiomas , systemically.
Surgery is generally reserved for small lesions(5-6cms)and as a secondary procedure after initial therapy andinvolution.
OtherTreatment modalities include injection ofsclerosing agents, cryotherapy, and ablation using anargon laser.
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THANK YOU
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