Another Question

[Soul]

An asymptomatic 3-year-old guy is brought to the physician because of right cheek swelling.The mother states that the pt. had been in his normal state of health until 1hr ago,when he developed rt. cheek swelling at a picnic. Patient is afebrile. Physical exam --unremarkable except for right cheek, which is erythematous but not warm to touch. On palpation of the right cheek, mildly tender, dicrete,indurated masses are appreciated. Which of the following is the most likely cause of this child's problem?
1.Erysipelas
2.Cellulitis
3.Trauma
4.Panniculitis
5.Contact dermatitis

Answer is very simple. GL

[unseennude]

i think its because of trauma

[Soul]

unseennude: good thinking but there is no history of trauma.

[Psychic]

Is it erysipelas..i guess so
well let us know.

[demon_dissector]

i say contact dermatitis...or simple terms allergy. from the history the child is having picnic and the child could have come in contact with bugs/ pollen anthing really.

[Soul]

The correct answer is 4- Panniculitis

If you get confused then use 'exclusion technique'.
Erysipelas--well demarcated,acute, pt. is ill looking, with fever, vomitings,irritability. In this patient no such s/s. so erysipelas excluded.
Cellulitis---distinct margins, warm, tender, indurated. So this one is also excluded.
Trauma--as I meantoned before, there is no H/O trauma..so excluded.
Contact dermatitis--erythematous/papulovesicular rash on xposure to contactant. Also there is no signs of contact dermatitis, so excluded.
What remained is-- panniculitis. n this is the correct answer.
Panniculitis---secondary to cold injury to fat and is characterised by the development of indurated lesions that resemble buccal cellulitis. Young children who hold popsicles in their mouths maybe prone to panniculitis n the same was happened in this boy while in picnic.

[Soul]

The famous Sherlock Holmes technique: "It is an old maxim of mine that when you have excluded the impossibility, whatever remains, however improbable, must be the truth." This technique is really helpful, dont u think so?

[Oak]

I am confused yarr....

I am not sure whether that was the history or the history part is incomplete or has been modified just to create the confussion because history is not correlating with the examination findings.

An asymptomatic 3-year-old guy is brought to the physician because of right cheek swelling.The mother states that the pt. had been in his normal state of health until 1hr ago,when he developed rt. cheek swelling at a picnic. Patient is afebrile. Physical exam --unremarkable except for right cheek, which is erythematous but not warm to touch.

This history doesn't match with the examination findings

On palpation of the right cheek, mildly tender, dicrete,indurated masses are appreciated.

Had it been panniculitis, symptoms doesn't develop in an hours (where as the symptoms has developed within hours in this case) it takes weeks to see the clinical symptoms in panniculitis. And panniculitis is diagnosed histologicaly only, after biospy of the tissues. But neither biopsy has been mention or the histological finding.

It is to be noted that panniculitis may be associated with fever (according to the history child is afebrile), abnormal liver function, involvement of the bone marrow, bleeding tendencies, nodular pulmonary lesions and evidence of pancreatic disease.

So, what do you guys think? is it still pannicultitis

[Vishal]

Originally Posted by Soul

The famous Sherlock Holmes technique: "It is an old maxim of mine that when you have excluded the impossibility, whatever remains, however improbable, must be the truth." This technique is really helpful, dont u think so?

Good technique, i like it

[demon_dissector]

the history is definitely incomplete. i'm confused, the history does not suggest panniculitis, i looked it up. i'm still going with contact dermatitis. it sounds more appropriate!