Repositório Científico da Unidade Local de Saúde de Santo António
Scientific Repository of the ULS Santo António
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Perinatal clinical case
Publication . Alves, Marta; Branco, Liliana; Lopes, Andreia; Pereira, Bárbara
A 16-day-old male was observed at the Emergency Department for a right cervical mass noticed on the same day by the parents, with no other associated symptoms. He was a fullterm child, delivered by vacuum extraction, with an uneventful perinatal period.
At the time of physical examination, a cervical mass was palpable in the inferior portion of the right sternocleidomastoid muscle, in association with ipsilateral torticollis.
Cervical ultrasound revealed a fusiform thickening of the sternocleidomastoid muscle, with well-defined, hypoechoic margins, confirming the diagnosis of fibromatosis colli.
Parents were instructed to adopt positioning measures and physical therapy was initiated, with clinical resolution by seven months of age.
Fibromatosis colli is the most severe presentation of congenital muscular torticollis. Although typical clinical findings usually enable the diagnosis, cervical ultrasound is useful to confirm muscular origin of the mass.
Torticollis in the opposite direction of the mass, spinal deformities, abnormal eye movements, or other abnormal neurological findings
Imaging clinical case
Publication . Martins, Cristiana; Ferreira, Jorge; Pereira, Gabriela
Introduction: Acute hemorrhagic edema of infancy (AHEI) is a rare and benign leukocytoclastic vasculitis, frequently misdiagnosed.
Case report: A twelve-month-old boy presented with a seven-day history of coryza and cough associated with lowgrade fever and the sudden appearance of a purpuric rash over the left lower limb. It progressed to an annular purpuric rash, with well-defined edges, on the face, limbs, ears, buttocks, and scrotum, with right tibiotarsal joint edema. Mild thrombocytosis was detected on laboratorial investigation. Patient was treated with a two-day course of oral betamethasone, with clinical improvement. No complications were reported within three weeks of follow-up.
Discussion: AHEI has a sudden onset and a benign, self-limiting course. This report may be a helpful reminder to discriminate AHEI from other, more serious diseases, avoiding exhaustive and unnecessary investigation.
Dermatology clinical case
Publication . Brandão, Pedro; Falcão-Reis, Inês; Rodrigues, Cátia; Ferreira, Vânia; Sá, Isabel
Ulcus Vulvae Acutum or Lipschütz ulcer is a rare cause of acute vulvar ulcer that usually affects young, non-sexually active women and consists on the sudden emergence of vulvar ulcers some days after an influenza-like syndrome, usually caused by Epstein-Barr virus. Despite its exuberant presentation, such ulcers are benign and self-limited. Diagnosis is clinical and treatment, symptomatic. Lesions typical resolve within a few weeks, leaving no scars.
The authors describe the case of a 17-year-old, sexually active female adolescent with Lipschütz ulcers.
Arthrogryposis multiplex congenita affecting a monochorionic diamniotic twin pregnancy
Publication . Brás, Rafael; Veloso, Helena; Moleiro, Maria; Rodrigues, Sofia; Inocencio, Gonçalo; Mota, Céu; Soares, Gabriela; Rodrigues, Maria Céu; Braga, Jorge
Arthrogryposis multiplex congenita is a clinically and etiologically heterogeneous group of diseases characterized by presence of contractures involving at least two different body areas. It is observed in one in every 3000−5000 live births. A case of singleton arthrogryposis in a spontaneous monochorionic diamniotic twin pregnancy is reported. Diagnosis was established after morphological ultrasound. There were no further complications during pregnancy. After cesarean delivery, diagnosis of amyoplasia involving the four limbs was confirmed. Newborn is currently undergoing motor rehabilitation. The higher risk of singleton arthrogryposis in monochorionic twin pregnancies is documented and appears to be related with vascular changes early in the course of pregnancy. In amyoplasia, some degree of disability and dependency is expected, even with postnatal rehabilitation.
A rare case of pediatric volvulus caused by a persistent omphalomesenteric cyst
Publication . Valpaços, Catarina; Costa, Mariana; Figueiredo, Suzana; Silva, Ana Raquel; Correia-Pinto, Jorge; Osório, Angélica
A persistent omphalomesenteric duct is one possible cause of small-bowel volvulus, a rare cause of acute abdomen in children. A four-year-old child was admitted to the Emergency Department with abdominal pain and incoercible vomiting, with neither abdominal guarding nor relevant abnormalities revealed in complementary diagnostic exams. Due to a significant clinical deterioration over a 48-hour observation period, the child was transferred to a tertiary hospital with pediatric surgery. An abdominal ultrasound revealing severe bowel distension and increased abdominal free fluid warranted an exploratory surgery, which identified a voluminous omphalomesenteric duct cyst. When symptomatic, treatment of this condition is consensual and consists of surgical excision of the anatomical abnormality, either by laparoscopy or conventional surgery. The latter was performed.
Conclusion: A persistent omphalomesenteric duct is a rare condition that generally requires a high level of clinical suspicion for diagnosis to be made, being most commonly detected during surgery. Associated complications and mortality rates are high, and a timely intervention is key, since surgical removal is the only treatment option.