1 / 30

CASE 2: ENT

CASE 2: ENT. General Data. J.Y. 13 y/o Female Single Filipino Roman Catholic from Butuan City, Agusan del Norte. Chief Complaint. Enlarged tongue. Px born to a 23 y/o primigravid via NSD at a tertiary hospital

camdyn
Download Presentation

CASE 2: ENT

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  1. CASE 2: ENT

  2. General Data • J.Y. • 13 y/o Female • Single • Filipino • Roman Catholic • from Butuan City, Agusan del Norte

  3. Chief Complaint • Enlarged tongue

  4. Px born to a 23 y/o primigravid via NSD at a tertiary hospital • (+) prenatal check-up, denies any exposure to radiation/ intake of teratogenic drugs • Admitted at a local hospital due to swelling and bleeding of tongue. • Given unrecalled antibiotics. • Advised to transfer to another hospital but px did not comply due to lack of funds. • Mother noted spontaneous resolution of tongue swelling. • Noted by the attending physician to have enlarged tongue. • No medications given, no further consultation advised. • (-) Difficulty feeding, dyspnea, snoring History of Present Illness • OB Hx • 12 years PTA • 13 years PTA

  5. Persistence of symptoms led to consult with a private ENT in Davao • (+) progressive enlargement of the tongue • (+) episodes of bleeding and swelling of the tongue 3-4x/ year. • Px would seek consult with MD and unrecalled antibiotics were given. History of Present Illness • 3 years PTA • Interval history (1997-2007)

  6. (+) persistent bleeding and swelling of tongue • (+) pain on the anterior 1/3 of the tongue. • Can only tolerate minced and soft foods. • Noted to be pale and weak by the mother. History of Present Illness • 2 months PTA ADMISSION

  7. Review of Systems • (-) weight loss • (-) skin rashes, changes in pigmentation • (-)blurring of vision, headache • (-) decreased hearing sensation, tinnitus, dizziness • (-)cough and colds, chest pains, palpitations • (-)abdominal pain, changes in bowel/bladder function • (-)edema, joint pains, muscle pains

  8. Past Medical History • (-) allergies • (-)PTB • (-) hepatitis • (-) asthma • (-) previous surgeries and blood transfusions

  9. Menstrual and Obstetric History • Menarche – 12 y/o • Irregular period • Duration: 4-5 days • Amount: 5 pads/day • Symptoms – dysmenorrhea

  10. Family History • (-) HPN • (-) DM • (-) Asthma • (-) PTB • (-) Ca • (-) Down’s Syndrome

  11. Personal and Social History • H – has good relations with other family members and persons at home • E – 1st year high school, average student • A – enjoys watching TV and DVD • D – no hx of illicit drug use, smoking, intake of alcoholic beverages • S – has few friends, rarely goes out • S – no sexual activity

  12. Physical Examination • Weight – 39 kg • Height – 144 cm • BMI – 20 • BP – 100/70 • PR – 84 bpm • RR – 22c pm • T – 36.7

  13. Physical Examination • Height for age – normal; Z score below -1 • BMI for age – normal; Z score 0 (median) • Conscious, coherent, ambulatory, not in cardiorespiratory distress • Warm moist skin, no rashes • Anicteric sclera, pink palpebral conjunctivae

  14. Physical Examination • Symmetric chest expansion, clear breath sounds • Adynamicprecordium, AB at 5th LICS MCL, no murmurs, no thrills • Flat abdomen, NABS, soft, nontender • Full and equal pulses, no swelling, no edema • SMR = 3

  15. ENT Examination • Anterior rhinoscopy: midline septum, turbinates not congested, no nasal polyps • Oral cavity: (+) enlarged reddened tongue; (+) multifocal, pebbly, vesicle like lesions on the tip, dorsal and lateral surfaces of the anterior 1/3 of the tongue; (+) blood clots on dorsal and ventral surface of anterior 1/3 of tongue; moist buccal mucosa

  16. ENT Examination • Pharynx – nonhyperemic posterior pharyngeal wall, tonsils not enlarged • Otology: AD – no tragal tenderness, nonhyperemic EAC, intact TM; AS – no tragal tenderness, nonhyperemic EAC, intact TM • Face and neck: no facial asymmetry, neck masses, thyromegaly, palplable lymph nodes

  17. Neurologic Examination • conscious, coherent, oriented to 3 spheres; • pupil 2-3 mm ERTL, EOMs full and equal • can clench teeth, can raise eyebrows, can close eyes tightly, can smile, can frown • no hearing loss, limited side to side head turning, tongue midline on protrusion • can do FTNT and APST • MMT 5/5 on all extremities • DTR ++ on all extremeties • no sensory deficits

  18. Salient Features

  19. MacroglossiaSecondary to Lymphangiomaof the Tongue Guide Question 1 What is your impression of the case?

  20. MACROGLOSSIA • large tongue or a tongue thatprotrudes beyond the teeth or alveolar ridge • most common cause of macroglossia is lymphangioma • Presents as tongue protrusion, which exposes the tongue to trauma. • Other symptoms include speech impediment, swallowing difficulties, airway obstruction, drooling, and failure to thrive. http://www.bcm.edu/oto/grand/52892.html

  21. LYMPHANGIOMA • Lymphangioma is a benign, harmatomatoustumour  of lymphatic vessels with a marked predilection for the head and neck region . • the lesions present superficially as a pebbly, vesicle-like feature with so-called ‘frog-egg’ or ‘tapioca-pudding’ appearance • equal sex incidence among males and females. • The lesions can become evident at any age but they usually appear in infancy

  22. most common presentation is a soft, painless mass that may enlarge with time and Hemorrhage into the lesion can also cause sudden enlargement. • The second and third most common presenting symptoms are respiratory obstruction and problems with feeding and failure to thrive. • Grossly, the lesions are ill-defined, diffuse, and spongy, having indiscrete margins. Often, it is actually much larger than it appears to be.

  23. Physical exam demonstrates a soft, painless compressible mass often described as being doughy on palpation. • Superficial tumors may be pink to reddish blue, while deeper lesions may show no surface changes or have stretched and atrophic skin. • Regional lymph nodes are either normal or hyperplastic. • Usually these lesions are asymptomatic and patients merely have a cosmetic deformity. Pain is not common unless infection is present.

  24. not a fatal disease. • 3% mortality rate which are usually due to bronchospasm, atelectasis, or airway compromise from edema. • There is no risk of malignant transformation. • The growth rate is variable but most lesions tend to progress slowly

  25. Biopsy of the Tongue Thyroid assays Imaging Studies: CT Scan, MRI of the Head & Neck Guide Question 2 What laboratory exams would you recommend?

  26. Biopsy of the tongue • Thyroid function test – to rule out hypothyroidism • Imaging Studies – to determine extent of lesion and pre-operative planning • CT Scan • MRI – test of choice

  27. Histologic Findings in Biopsy of the Tongue

  28. Tongue Resection and Reconstruction Guide Question 3 What will be suggested treatment?

  29. PUT YOUR DISCUSSION • No proven medical care for lymphangiomasexists. This condition is not responsive to radiation therapy or steroids.

More Related