by ny s, hemangioma dd limfangioma

NY S BABY, HEMANGIOMA DD/LYMPHANGIOMA

CASE REPORT

• Baby S, female, 1 days, Come to Hasanuddin university hospital referred from north kolaka hospital, with right pectoralis tumor, since she was born.

• Dyspnoe +• No fever, convulsion,

cough, and vomiting

• History of pregnancy : not routinely checkup to midwife or doctor, no previous history of using any medication and traditional medicine, at final trimester the mother was diagnose having large cyst in USG imaging, and the obsgyn decide to do the SC

• History of Delivery : this term baby born via SC, immediately cry, active muscle tone, with Apgar score 7/9, with BW : 4,6 kg and Length 45 cm

• No family history of malignancy• No family history of hemangioma

PHYSICAL EXAMINATION• Active and Term Baby, BW : 4490 gr, Length 45 cm, HR :

148 times/min, RR : 68 times/min, T : 37,1 ,no birth trauma

• Chest examination : Respiratory distress• tumor in right pectoralis and axillaris region, size 20 x

11 x 6 cm, soft consistency, flat surface, colour and temperature were same with surrounding surface, no tenderness

• Other System : Within normal limit• Gestational Age : 38 Weeks

Laboratory Examination

Blood Routine : Hgb 16,9 g/dl, Wbc :

12.370, Hct : 44,8 %, Plt : 414.000, ANC 8300,

Blood Glucose : 72 mg/dl

IMAGINGCHEST X RAY :

Result :Pulmonary and Heart within normal limit

Soft Tissue Mass regio Shoulder Dextra

IMAGING

• USG Doppler : Result :

Suspected Diffuse Hemangiomatosis dd/ Lymphangioma

• Massa kistik berseptasi regio axilla kanan suspek suatu diffuse hemangiomatosis

dd/ Lymphangioma• Efusi Pleura Kanan

MS CT SCAN

FNAB RESULT

CT ANGIOGRAFI

RESULT

Massa regio axillaris dextra sigestif hemangiomatosis

dengan feeding artery kesan berasal dari pars proximal

arteri brachialis dextra

WORKING DIAGNOSIS

• Respiratory distress of Newborn• Soft tissue mass Regio pectoralis dextra

dd/Hemangioma, Lymphangioma• Aterm Baby/ Large for Gestasional Age

16/7/2015Ukuran tumor 20 x 11 x 6 cm

17/7/2015Ukuran tumor 20 x 11 x 6 cm

28/7/2015Ukuran tumor 18 x 16 x 5 cmDrain : 210 cc

30/7/2015Ukuran tumor 16 x 13x 2,5 cm

1/8/2015Ukuran tumor 10 x 10 x 2,5 cmDrain 1045 cc

2/8/2015Ukuran tumor 8,5x 6 x 5 cmDrain : 90 cc

DECUBITUS ULCER

Secrete from the Drain

28/7 30/7 31/7 1/8 2/8 3/8 5/8Hb (g/dl) 10,2 11,2 9,8 13,1 9,7

Wbc (cell/ul)

12.870 17.060 11.460 9440 7010

Hct (%) 29,8 32,1 28,7 28,3

PLT 560.000 379.000 452.000

416.000 357.000

Ureum/Kreatinin (mg/dl)

6/0,1

Albumin(g/dl)

2,4 3,1 2,4 2,8 2,9

Na/K/Cl (mmol/L)

139/5.6/108

LABORATORIUM

RECENT TREATMENT

• PRC Transfusion (3 times)• Albumin Transfusion (3 Times)• Enteral Nutrition • IVFD Asering• Antibiotics : Ceftazidime & Gentamycin• Propanolol 0,5 – 2 mg/kg/day• Wound care with Bactroban and Oxoferin

THANK YOU

Classification of Vascular Anomalies, Pediatrics. Volume 13.2015