Case of a 45 year old Female with a swelling at the occiput


Note : This is an ongoing case , this E-log would be updated as and when we get new information .


CHIEF COMPLAINT - The patient presented with chief complaints of a painful swelling at the back of the neck from the past 2 months .

HISTORY OF PRESENTING ILLNESS

The patient was apparently asymptomatic 6 months back

6 months ago the patient noticed a swelling at the occiput . As the swelling was painless the patient did not get it checked .

The size of the swelling was also small (Exact dimensions are not known )

2 months ago , the patient expressed that the swelling turned painful and was tender.At this point the patient visited a local hospital in Siliguri and was given pain relief medication (The patient does not remeber the name of the medication ). There was no change in the size of the swelling .

One week back , the patient developed a swelling in the back with no complains of pain or tenderness.

One week back the patient also complained of Headache and pain in the sinuses, with blurring of vision.

One week ago the patient visited our hospital   

HISTORY OF PAST ILLNESS

History of : Hypertension 

No history of Diabetes Mellitus  , CAD, Asthma , TB



DRUG HISTORY
The patient was treated for hypertension but was not able to recollect the name of the medication  


PERSONAL HISTORY

  • Married
  • Occupation : Farmer
  • Appetite - normal
  • Bowel movements : Regular
  • Micturition : Normal
  • No history of alcohol consumption
FAMILY HISTORY

No relevant family history

GENERAL EXAMINATION
  • The patient is concious coherent , Oriented to time place and person
  • Pallor - absent
  • Icterus - Absent
  • Cyanosis - Absent
  • Clubbing - absent
  • Koilonychia - Absent
  • Lymphadenopathy - absent
  • Edema - Absent

VITALS
  • Temperature : Afebrile
  • Respiratory rate- 18 beats per minute
  • Pulse rate : 69 /minute
EXAMINATION OF THE SWELLING at the occiput

  • Situation : Occiput
  • Shape: slightly raised , flat , rectangular
  • Size:
  • Surface : smooth
  • Edge : smooth margins
  • Temperature of the swelling : slightly raised
  • Consistency : Uniform consistency , soft swelling
  • Reducibility of the swelling : absent
  • Compressibility : Present , the swelling reappears when the pressure is removed .


CVS EXAMINATION

  • S1, S2 heard
  • No murmurs or thrills

RESPIRATORY SYSTEM EXAMINATION

  • No abnormal breath sounds
PER ABDOMEN

No tenderness ,palpable mass or free fluid
Non palpable spleen or liver

CNS EXAMINATION

  • The patient is concious
  • She has normal speech
  • Cranial nerves are normal
  • Motor ans sensory system - normal
  • No finger nose incoordination or knee heel incoordination


DIAGNOSIS : HEMANGIOMA 

TREATMENT :

Embolization : it is the therapeutic introduction of various substances into the circulation that inhibit the growth or bleeding of vascular tumors.  

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