Case Presentation (swelling fore arm in a child)

Department of Paediatric Surgery Civil Hospital Karachi

BIODATA
Six months old baby girl, resident of Jacobabad, came to the Out Patient Department of Paediatric surgery with! Presenting complaint of: swelling on Left Forearm since 5 months.

H.O.P.C.
According to her mother she was alright 5 months back then her mother noticed a small red/purple colored nodule which was gradually increased in size and during 5 month period it reached up to the size of 5x5 cm, initially they visited GPs of local area but didnt get benefit, then they decided to go Civil Hospital Karachi.

History
Past History: no significant past Medical or Surgical history. Family History: only child of her parents. No family history of such type of disease. Personal History: her sleep and feeding habits are regular.

History
Birth History: no antenatal visits of her mother, delivered at home by dai, no significant post natal history. she is on mother feed.

Examination
5x5 cm swelling on anteriolateral surface left upper forearm just below the elbow joint, swelling is soft to firm, non-tender, temperature is not raised, its floor is ulcerated and its margins turned to red/purple color and are irregular, it is not reducible/compressible, having no pulsation or bruit. No distal Neurovascular deficit.

DIAGNOSIS ?

hemangioma

Hemangiomas
Hemangiomas, comprising approximately 7% of all benign soft tissue tumors .

Development
The hemangioma is a true vascular tumor that results from a overgrowth of normal vascular tissue .

It exhibits relatively rapid early growth until approximately 6 to 8 months of age (proliferative phase), followed by regression by 5 to 9 years of age (involutory phase).

Development
The majority of the Hemangiomas in infants are noted by the parent within the first month of life. Hemangiomas are initially noticed as an erythematous, macular patch, which progresses through a rapid proliferative phase whereby it changes its color and grows faster than the commensurate growth of the child.

Clinical presentation
By the time the patient is 12 months of age most Hemangiomas have shown of involution. The process of involution is normally slow and will not be completed until the age of 5 to 9 years.

Clinical presentation
Hemangiomas are found in the superficial tissue, the deep tissue, or both and may affect organ systems such as the liver, lung, spleen, and gastrointestinal tract. Most superficial Hemangiomas can be diagnosed by clinical examination and a detailed and accurate history.

Clinical presentation
Deep Hemangiomas involve muscle or visceral organs and, are more difficult to diagnose. Therefore, further diagnostic studies are required. Intra-osseous Hemangiomas are extremely rare.

The predilection for females is approximately a 3 :1 ratio.

Investigations
Ultrasound Computed tomography (C. T .Scan) and Magnetic resonance imaging ( M. R. I) imaging techniques are used as diagnostic aids to document the extent of the deep Hemangiomas.

 Arteriography is rarely indicated

for the diagnosis of a Hemangiomas.

Management
Observation and parental support are the initial approaches in the management of maxillofacial Hemangiomas.

If functional compromise such as visual change, airway or masticatory compromise, bleeding, ulceration, or infection occurs intervention is necessary.

Management
Wait & watch- many small haemangiomas involute spontaniously. This may initially involve cortico-steroids for rapidly proliferating 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 and involution.

OtherTreatment modalities include injection of sclerosing agents, cryotherapy, and ablation using an argon laser.

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