1/23. Aneurysm of the ascending aorta in a neonate.Aneurysms of the thoracic aorta rarely occur in children. We present a female neonate who was referred to our hospital due to a heart murmur associated with cough and fever at 22 days of age. Both the echocardiography and aortography displayed an aneurysm of the ascending aorta at the aortic root. A patent ductus arteriosus (PDA) flow was detected on admission but it was not detectable when she was 3 months old. Neither physical characteristics of Marfan nor turner syndrome were found, but she has had a huge cutaneous hemangioma over the right trunk since birth. The aneurysm did not progress during one year of follow-up. The etiology might be idiopathic or medial agenesis. Surgery will be warranted only if the aneurysm enlarges.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
2/23. Temporoparietal fascial flap in orbital reconstruction.OBJECTIVE: To evaluate the success of the temporoparietal fascial flap (TPFF) in the primary or secondary reconstruction of difficult orbital defects and to review the surgical techniques. DESIGN: Retrospective analysis. SETTING: Tertiary medical center. patients: Nine patients with diverse orbital cavity or periorbital soft tissue and bony defects due to trauma, benign or malignant neoplasms, and radiation treatment. INTERVENTIONS: Temporoparietal fascial flap anatomy and techniques of harvest and inset are reviewed in detail. Four cases are presented to illustrate possible variables in orbital reconstruction. Variables examined include the location of defects, the success of flap survival in orbital cavities after primary or secondary reconstruction, the effects of prior irradiation on flap survival, and the possibility of concurrent osteointegrated implant placement with TPFF reconstruction. MAIN OUTCOME MEASURES: Functional and aesthetic outcomes were determined by physical examination and preoperative and postoperative photographs. RESULTS: All patients had successful transfer of TPFF grafts without flap compromise. Temporoparietal fascial flap was a viable option for subtle orbital and malar contour defects. In chronically inflamed wounds such as with osteoradionecrosis and orbitoantral fistula, TPFF successfully restored vascularity, obliterated the defects, and enabled the placement of osteointegrated implants. The TPFF also supported the concurrent placement of a free calvarial bone graft. Finally, split-thickness skin grafted onto a pedicled TPFF showed 100% survival. CONCLUSIONS: The TPFF is one of the most reliable and versatile regional flaps in the head and neck for orbital reconstruction. This study presents the use of TPFF in a variety of orbital defects, from lateral bony rim defects to total exenteration. Timing of repair in this study spans from immediate reconstruction to reconstruction delayed more than 50 years after the initial injury. In all cases, reconstruction with TPFF resulted in improved bony and soft tissue contours, and incurred minimal morbidity.- - - - - - - - - - ranking = 11.673873798708keywords = physical examination, physical (Clic here for more details about this article) |
3/23. Report of a child with aortic aneurysm, orofacial clefting, hemangioma, upper sternal defect, and marfanoid features: possible PHACE syndrome.We report a female patient who had a scalp hemangioma, a cleft uvula, an upper sternal defect, pectus excavatum, arachnodactyly, pes planus, and joint hypermobility. She had rupture of an aortic aneurysm after minor trauma at 11 years of age. At 17 years of age, elective repair of a dilated, ectatic aorta was complicated by cerebral ischemia. Other vascular abnormalities in the proband included an aneurysm of the left subclavian artery, atresia of the right carotid artery, and calcified cerebral aneurysms. We believe that the proband's physical anomalies are best described by the PHACE (posterior fossa brain malformations, hemangiomas, arterial anomalies, coarctation of the aorta and cardiac defects, and eye abnormalities) phenotypic spectrum. This spectrum of physical anomalies also includes sternal clefting and hemagiomas as part of the sternal malformation/vascular dysplasia (SM/VD) association, as found in our patient, and the acronym PHACES has also been used. We consider that the PHACE phenotypic spectrum is likely to be broader than previously recognized and includes orofacial clefting and aortic dilatation and rupture. Our patient also had skeletal anomalies that lead to consideration of marfan syndrome as a diagnosis. It should be recognized that there is clinical overlap between PHACE syndrome and marfan syndrome when aortic dilatation is present. We would also like to emphasize the minor nature of the cutaneous findings in our patient despite her severe vascular complications. This is in contrast to previous reports of large or multiple hemangiomas in PHACE syndrome.- - - - - - - - - - ranking = 2keywords = physical (Clic here for more details about this article) |
4/23. A patient with extensive blue rubber bleb nevi associated with multiple congenital anomalies: an overlap or a new syndrome?We report a case of a 13 year old boy with non-familial, multiple blue rubber bleb nevi (BRBN). He also had additional dysmorphic anomalies including a low hairline, low set ears, narrow nares, ptosis, hypotelorism, a high arched palate and downward slanting of the outer canthi. Skeletal deformities included a short, slightly webbed neck, kyphosis, cubitus valgus, non-traumatic luxation of the head of the right radius and a short left little and index fingers. He had no evidence of gastrointestinal lesions or bleeding, congenital heart or renal disease or enchondromata. The boy was mentally slow compared to his peers. He had normal chromosomes. The absence of gastrointestinal bleeding or iron deficiency anaemia is inconsistent with Bean's syndrome and the lack of enchondromata in this patient militates against the diagnosis of classical Maffucci syndrome. Some of his physical features are obviously similar to those observed in a Noonan's syndrome yet the presence of extensive BRBN would be an extremely unusual finding. Since the overall picture does not fit into any of the classical categories mentioned above, the constellation of his features has yet to find a specific syndrome. It may, however, represent an overlap between them or, possibly, a new syndrome.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
5/23. Intraosseous arteriovenous malformation in a pediatric patient.An isolated tibial intraosseous arteriovenous malformation was diagnosed in a seven-year-old boy. This malformation was not associated with any major clinical symptomatology except pain. It had a paucity of physical findings and was not well visualized with conventional radiography. It was not associated with any soft-tissue or cutaneous manifestations and it was entirely intramedullary, with minimal cortical involvement. This case illustrates the value of magnetic resonance imaging in the localization of these lesions. The absence of radiation exposure, coupled with the noninvasive nature, makes magnetic resonance imaging important in evaluating an intramedullary process in a pediatric patient.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
6/23. Hemangiomas: new insights and classification.Infantile hemangiomas are the most common tumors of infancy, but less common vascular tumors also can affect young infants and children. In most cases, the diagnosis of IH can be made clinically, but imaging studies and even biopsy may be required in less-than-typical cases. With a careful history and physical examination focusing on the timing, location, and type of hemangioma, as well as extracutaneous signs and symptoms, the general pediatrician will know when to be concerned about a high risk vascular tumor and proceed with referral or further evaluations.- - - - - - - - - - ranking = 11.673873798708keywords = physical examination, physical (Clic here for more details about this article) |
7/23. Central haemangioma: variance in radiographic appearance.Central haemangioma, a "great mimicker" which, fortunately, is a relatively rare condition, may pose a lethal risk for the patient. The diagnosis may become apparent only during biopsy or tooth extraction, which poses a risk of lethal exsanguination; therefore a correct diagnosis is desirable before any biopsy is undertaken. The clinician may not anticipate the severe haemorrhage because of vague clinical history, physical findings and ambiguous radiographic characteristics of the lesion. We report a case of central haemangioma of the mandible whose clinical and radiographic features were equivocal. In addition, an attempt is made to discuss all possible radiographic presentations of central haemangioma and consider differential diagnosis. This case is significant for the reason that it had diverse radiographic appearances in various areas of the lesion in different projections.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
8/23. Intercostal hemangioma presenting as a chest wall tumor.Skeletal muscle hemangiomas are uncommonly described in a variety of locations. This report details the diagnosis and management of a 39-year-old woman with a right chest wall mass detected on physical examination. After a negative diagnostic evaluation, exploratory thoracotomy revealed an intercostal hemangioma, undescribed in recent literature. The lesion was excised.- - - - - - - - - - ranking = 11.673873798708keywords = physical examination, physical (Clic here for more details about this article) |
9/23. A large benign vascular neoplasm of the male breast. A case report and review of the literature.breast hemangiomas are extremely rare neoplasms in the male population. We report a case of a 77-year old man with a breast hemangioma which was detected in physical examination as a small nodule ten years after a chest injury. The final histological diagnosis was hemangioma of the breast, 6 cm in the largest diameter. To our knowledge, this is the largest benign vascular breast neoplasm in a male patient reported up to date. The mammographic and pathologic findings in this case are presented. The rarity of the lesion and its differential diagnosis from angiosarcoma are discussed while the problems encountered in the correct diagnosis and classification of this tumor are also presented. The need for extreme caution in the interpretation of the histological characteristics of all palpable vascular tumors of the breast is emphasized.- - - - - - - - - - ranking = 11.673873798708keywords = physical examination, physical (Clic here for more details about this article) |
10/23. Angiomatous malformation: a rare cause of recurrent swelling of the knee joint.Angiomatous malformation of the muscle around the knee joint is an extremely uncommon cause of recurrent swelling of the joint. We report a case of a 13-year-old boy who presented with recurrent episodes of knee joint swelling. Though the history and physical examination was typical, magnetic resonance imaging clinched the diagnosis.- - - - - - - - - - ranking = 11.673873798708keywords = physical examination, physical (Clic here for more details about this article) |
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