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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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