Scalp Swelling Research Articles

A Case Report of an Invasive Scalp Actinomycosis

Background: Actinomycosis is a bacterial infection characterized by a chronic, suppurative and granulomatous process. The causative organism was identified in 1891 as Actinomycosis israelii. The disease is usually caused by the introduction of the bacteria through minor wound. Actinomycosis was classified by Cope into 3 different forms: cervicofacial (50%), pulmonothoracic (30%) and abdominopelvic (20%). Actinomycosis is an insidious disease but occasionally the clinical course can be more aggressive, involving underline tissue and organs. Involvement of scalp by actinomycosis is rare causing diagnostic dilemma and could be mistaken for different pathologies, such as tuberculosis or carcinoma. The most common clinical findings are local tumefaction with abscesses and sinuses draining pus that contains the granule of the causative organism. CT scan and MRI are aspecific for diagnosis, but they can help in defining the localization and the extension of the lesion. The certain diagnostic is based on cytology and/or biopsy. Case: A 24 year-old-man was admitted to our neurosurgical department with a 16-month history of multiple scalp ulcerated lesions and swelling of the head. He was complaining of headache. Physical examination revealed multiple scalp subcutaneous nodules and ulcerated lesions with swelling of the head. Our examination of the oral cavity revealed a poor oral hygiene condition with multiple caries. The CT scan revealed multiple scalp subcutaneous masses with chronic inflammatory changes of the skull. Routine laboratory test was normal. Surgical biopsy was performed and the histological result was compatible with actinomycosis. After histological confirmation, parenteral Penicillin 20 million units daily were given for 4 weeks. Clinical improvement was observed after completing a 4-week regimen of intravenous antibiotics. Conclusion: Involvement of scalp by actinomycosis could be mistaken for different pathologies, such as tuberculosis or carcinoma. This emphasizes the importance of biopsy for histological confirmation of the disease.

Cutaneous nodules as a first presentation in triple-negative breast cancer

Out of all skin neoplasms, metastasis accounts for only about 2%, and breast cancer is the second commonest malignancy to metastasize to the skin after malignant melanoma. Although triple-negative breast cancer patients tend to have metastatic disease at presentation, cutaneous metastasis is unusual. In this report, we present a 47-year-old asymptomatic woman whose attention was drawn by her hairdresser to a scalp swelling 2 months prior to presentation. Similar swellings were noticed on the back, arms, and thighs. One month later, a left breast lump was noticed during a clinical breast examination by a physician. She was in good physical condition but had generalized cutaneous nodules. Further investigations revealed canon ball metastasis to the lungs, and histopathology with immunohistochemistry confirmed triple-negative invasive ductal carcinoma with cutaneous metastasis. Skin involvement in breast cancer signifies advanced disease. Therefore, high index of suspicion is necessary so as not to overlook early sinister nodules as benign dermatological condition.

Contemporary management of scalp cirsoid aneurysm: A dual-trained neurosurgeon’s perspective

ObjectiveScalp cirsoid aneurysms are subcutaneous arteriovenous fistulae fed by branches of the external carotid artery. They present with progressive scalp swelling and cosmetic deformities in addition to neuro-vascular symptoms. We evaluate the treatment and outcome of this rare vascular lesion with surgery and adjunctive endovascular embolisation performed by a dual-trained neurosurgeon. MethodsA retrospective analysis of 6 cases operated over a 16 year-period was performed which comprised of clinical data, radiology including angiography and pre-operative embolisation, surgical approaches, outcomes and complications. Results6 patients with ages ranging between 26 and 51 years were operated in the study period. All the patients underwent surgical excision of the lesion, of which 2 had undergone pre-operative embolisation of the feeders. There was no recurrence in the follow-up period (Mean 4.7 years) following total excision of the lesions. One patient had post-operative wound dehiscence and another had migration of embolic material to lungs. ConclusionSurgery is the predominant treatment method for scalp cirsoid aneurysms. Various adjunctive endovascular procedures can be performed pre-operatively to minimise operative blood loss.Though lower recurrence is seen with surgery for the scalp AV fistula, embolisation performed in select cases can achieve curative results with appropriate techniques.

Cytodiagnosis of scalp swelling: An uncommon presentation of a common neoplasm

Cytodiagnosis of scalp swelling: An uncommon presentation of a common neoplasm

An Infant with Infected Cephalohematoma


 
 
 Cephalohematoma is a benign medical condition affecting 1 to 2% of all live births, which resolves spontaneously in most of the cases. Infected cephalohematomas are very rare and serious as they can cause sepsis, osteomyelitis and meningitis.
 We report a case of 40 days male who presented to our outpatient clinic with ruptured scalp swelling. Deep seated scalp abscess was incised and drained. Culture proved E.Coli infection which was managed with intravenous antibiotics for 5 days during the hospital stay and was later discharged on oral antibiotics. The wound completely healed with no evidence of residual abscess on 1-week follow-up.
 Infected cephalohematoma has good prognosis if appropriately drained and managed on culture guided antibiotics.
 
 

Delays in care seeking for young children with accidental skull fractures are common.

We sought to determine the frequency and patterns of delayed medical care seeking for young children with skull fractures. We identified accidental skull fractures <4years old, 2011-2012. Child abuse paediatricians abstracted retrospective data and paediatric radiologists re-reviewed images. 'Delays' were defined as presentation at ≥6h. 'Minor accidents' included falls <4 feet and low force trauma, while 'major accidents' included higher height falls and major force events. We studied the frequency and duration of care delays, the signs or symptoms leading to care, and the duration of delays after signs or symptoms developed. Two hundred and ten children had accidental skull fractures. Delays were less likely with major accidents (4.9%), than with minor accidents (25.8%) (RR=0.32 [0.15-0.70]). Children came to care for scalp swelling (STS) (39%), the injury event (36.2%), altered consciousness (15.2%) and vomiting (10.5%). Delayed onset of STS (78.6%) caused most delayed care. Early STS was firm, (17.6%) versus delayed (5.0%), as opposed to soft or fluctuant. Delayed care seeking is common for minor, but not major accidental infant and toddler skull fractures. Most followed delayed onset of signs and symptoms. Delayed care seeking alone should not imply child abuse.

Design and clinical application of specialized protective cap for patients with alopecia after autologous hair transplantation

Objective: To investigate the design of specialized protective cap for patients with alopecia after autologous hair transplantation and its application value in nursing care after autologous hair transplantation. Methods: The author designed a kind of specialized protective cap for patients with alopecia after autologous hair transplantation with elastic gauze, fiber, silica gel, and other materials. It was divided into two parts, the front piece was mainly used to protect the hair receiving site, and the back piece was mainly used for pressure hemostasis at the hair donor site. From February 2017 to January 2019, 81 patients with alopecia and had autologous hair transplantation in the First Affiliated Hospital of Air Force Military Medical University, who met the inclusion criteria, were enrolled in this prospective controlled study. According to the tail number of admission number of each patient, 43 patients with odd numbers were recruited in protective cap group (38 males and 5 females, aged 23 to 52 years) and 38 patients with even numbers were recruited in convention group (34 males and 4 females, aged 22 to 55 years). After hair transplantation surgery, patients in the two groups received routine postoperative education. Patients in the conventional group were treated with conventional dressing after surgery. On this basis, patients in protective cap group wore the specialized protective caps for at least 1 week continuously except for necessary dressing change, wound clean, and dressing remove. The follow-ups was performed by responsible doctors and nurses at clinic. The postoperative hemorrhage at the hair donor site on post surgery day (PSD) 3 and swelling of scalp at the surgical site on PSD 7, the folliculitis at the hair receiving site and survival condition of transplanted hair follicle at the receiving site, and satisfaction score within 3 months after surgery were observed and recorded. Data were statistically analyzed with two independent sample t test, chi-square test, and Fisher's exact probability test. Results: (1) On PSD 3, one patient in protective cap group had hemorrhage at the hair donor site, which was significantly less than 8 patients in convention group (P<0.05). (2) On PSD 7, 4 patients in protective cap group had swelling of scalp at the surgical site, which was significantly less than 11 patients in convention group (χ(2)=5.160, P<0.05). (3) Within 3 months after surgery, 0 patient in protective cap group had folliculitis at the hair receiving site, which was less than 3 patients in convention group. (4) In 3 months after surgery, the survival number of hair follicle in each 100 transplanted hair follicles at the hair receiving site of patients in protective cap group was 94.9±2.8, which was significantly more than 91.1±4.7 in convention group (t=4.354, P<0.01). (5) The patients' satisfaction score in protective cap group was (14.2±2.6) points, which was significantly higher than (12.1±3.0) points in convention group (t=3.338, P<0.01). Conclusions: After autologous hair transplantation, the specialized protective cap can reduce postoperative hemorrhage at the hair donor site, swelling of scalp at the surgical site, as well as improve the survival rate of transplanted hair follicles at the hair receiving site and score of patient satisfaction.

Non-small Cell Lung Cancer Presenting as Parotid and Scalp Swellings: A Rare Clinical Presentation

Metastases to the parotid gland as first presentation of lung cancer are extremely rare and occur in

SAT-499 Myxedema Coma Presenting as Large Pericardial Effusion with Cardiac Tamponade

BackgroundMyxedema coma is a life-threatening decompensated form of hypothyroidism. Current treatment recommendation is intravenous levothyroxine. However, in areas where parenteral form of levothyroxine is unavailable, levothyroxine tablet is the only option.Clinical CaseA 48-year old male known to have chronic glomerulonephritis and hypertension, came in due to lacerated scalp wound sustained after falling asleep. Pertinent laboratory exams showed mild anemia, hemoglobin 10.6 g/dL (reference range 13–17) and hyponatremia 128mmol/L (reference range 136–145). His estimated creatinine clearance was 60mL/min. Cranial CT scan showed no signs of acute hemorrhage or fracture. There was scalp swelling and laceration with subgaleal hematoma over the frontal region. Electrocardiogram showed low voltage complexes. Chest radiograph showed an enlarged cardiac silhouette suggesting pericardial effusion. Transthoracic echocardiography was requested revealing a massive pericardial effusion with tamponade physiology. Patient underwent emergency pericardial window with pericardiostomy tube placement, debridement and suturing of scalp laceration under general anesthesia. He was able to tolerate the procedure well but noted to have decreased sensorium post-operatively. ABG revealed respiratory acidosis with pH 6.9 and incalculable pCO2. He was subsequently intubated. Further laboratory investigations showed undetected FT4 0.0ng/dL (reference range 0.58–1.64) and elevated TSH 23.87µIU/mL (reference range 0.38–5.33). Anti-TPO was elevated 333 µIU/ml (reference range 0–35). He was started on hydrocortisone followed by levothyroxine 200 µg tablet through NGT daily. His condition improved after few days and was weaned off from mechanical ventilator. Repeat echocardiogram showed resolution of previously noted massive pericardial effusion with preserved systolic and diastolic functions. He was eventually discharged after a month on levothyroxine. Follow-up after 1 month, patient was clinically stable with normal thyrotropin level at 0.67µIU/mL.ConclusionMyxedema coma is a life threatening form of hypothyroidism and may be difficult to recognize initially especially in patients with pre-existing kidney disease due to overlap in clinical findings. Treatment with levothyroxine administered enterally is possible especially if the intravenous form is unavailable.

Trichoblastic Carcinoma of the Scalp: a Case Report on a Rare Condition

Trichoblastic carcinoma is a rare malignant adnexal tumor arising from the hair follicle. It is often difficult to differentiate it from basal cell carcinoma given its similarities on histopathology. However, it is important to arrive at a definitive diagnosis given its tremendous potential to metastasize as compared with basal cell carcinoma. Here we report a case of a 52-year-old man with an indolent scalp swelling. A surgical excision followed by a histological study showed trichoblastic carcinoma. A revision surgery was done later with adequate margins which were tumor free on histology. Very few cases of such diagnosis are available at our disposal.

Acute Soft Head Syndrome in Sickle Cell Disease in Qatif Central Hospital, Saudi Arabia—Case Report and Review of the Literature

Acute soft head syndrome or sickle cell cephalohematoma is not a common sequel or complication of Sickle cell disease (SCD). Here we describe a case report of a 15-year old Saudi male with sickle cell disease who presented with generalized vaso-occlusive crisis. 48 hours post admission, he developed generalized scalp swelling which is consistent with one of the rare complications of sickle cell disease, acute soft head syndrome. The patient was treated conservatively, without aspiration of the scalp swelling. This case draws attention that acute soft head syndrome should be one of the differential diagnoses of scalp pain and swelling in patients with sickle cell disease.

Multiple Infantile Myofibromatosis with Skeletal Abnormalities

Background: Infantile myofibromatosis is an uncommon disorder characterized by multiple fibromatous tumours involving skin, bone, muscle, viscera and subcutaneous tissue. It is a rare benign mesenchymal tumour; most commonly occurs in infancy or early childhood. The clinical presentation can mimic malignant tumours of infancy or childhood. Case Presentation: We describe a rare case of multicentric Infantile myofibromatosis in a 6-month-old infant presenting with multiple scalp swellings and associated skeletal abnormalities (adducted thumbs, clinodactyly and bilateral hallux valgus deformity of great toes). The case required surgical excision of all scalp lesions and orthopedic manipulation of skeletal abnormalities. Conclusion: Infantile myofibromatosis presenting as multiple lesions in the scalp associated with skeletal abnormalities, is very rare. To best of our knowledge, the unique combination of the distinct skeletal abnormalities in infantile myofibromatosis has not been reported so far. This report emphasizes the possibility of skeletal abnormalities in infantile myofibromatosis.

Erythematous Nodular Scalp Swellings Showing Central Ulceration and Hemorrhagic Crusting in an 83-year-old Man.

Erythematous Nodular Scalp Swellings Showing Central Ulceration and Hemorrhagic Crusting in an 83-year-old Man.

Parahaemophilia presenting as an interesting scalp swelling.

Parahaemophilia presenting as an interesting scalp swelling.

Congenital Cervical Mass in a Neonate with Secondary Scalp Swelling.

Congenital Cervical Mass in a Neonate with Secondary Scalp Swelling.

Transcalvarial and Transdural Involvement of Skull Actinomycosis with Recurrence

AbstractActinomycosis is caused by anaerobic gram-positive bacteria of Actinomyces genus, generally found as commensals in the human body and infection occurs when the immune system is compromised. We present the case of a 35-year-old diabetic woman, who presented with headache and sudden onset of left-sided weakness apart from scalp swelling, which on imaging showed transcalvarial transdural involvement, and subsequent surgical debridement and histopathologic analysis confirmed actinomycosis. Follow-up showed recurrence of the lesion at the same site following a period of remission. Calvarial involvement of actinomycosis is rare and can mimic even neoplastic or malignant lesions, hence requiring prompt diagnosis, treatment with surgery, and long-term antibiotic treatment to prevent complications.

Diagnostic rescue of a silent scalp swelling by fine-needle aspiration.

Diagnostic rescue of a silent scalp swelling by fine-needle aspiration.

Infantile Scalp Swellings Beyond the Immediate Postpartum Period

INTRODUCTION Scalp swellings in newborn infants are common in the immediate postpartum period. Unlike caput succedaneum, the most common and short lived variant, cephalhematomas and subgaleal hemorrhages both involve blood accumulation, either under the cranial periosteum or aponeurosis, respectively, and can persist for weeks. However, eventually, they do resolve and do not recur. When an infant comes to medical attention with a new scalp swelling without having sustained postpartum scalp trauma, or with a history of postpartum scalp trauma that had already resolved, the question of whether the …

Scalp Swelling and Spinal Dimpling in Two Term Infants

A female neonate is noted to have a painless scalp swelling on routine newborn examination. ### Prenatal and Birth Histories ### Presentation Routine newborn examination on the 1st day after birth was notable for a focal 1.2-cm swelling adjacent to the sagittal suture midway between the anterior and posterior fontanelles (Fig 1). Figure 1. Cystic scalp lesion anterior to the posterior fontanelle. ### Vital Signs ### Physical Examination (Day 1)

Cytological diagnosis of Langerhans cell histiocytosis: A series of 47 cases.

Langerhans cell histiocytosis (LCH) is a rare disease affecting predominantly children and young adults but can be found in any age group. Diagnosis of LCH is often difficult and can be delayed because of its rarity. The present study highlights the cytomorphological features in a large cohort of cases. An accurate cytological diagnosis may avoid unnecessary biopsy and guide appropriate management. Fourty seven (47) cases of LCH diagnosed on cytological material & fine-needle aspiration (FNA) over a period of 14 years (2003-2016) were retrieved from the archives. The cytological smears were evaluated and microscopic findings collected by semi-quantitative assessment done by two different pathologists RESULT: The age at the diagnosis of the patients ranged from 9 months to 28 years. The majority of cases were in the age group of 0-5 years. The most common site was head and neck region, which included cervical lymphadenopathy and scalp swelling. Two cases were diagnosed each from inguinal lymph node and bronchio-alveolar lavage (BAL). Cytological smears in the majority of the cases were moderate to highly cellular (58%) and showing abundant Langerhans cell in (72%) of cases. Areas of necrosis were seen in 38%, while 78% of cases showed giant cells. The majority of cases showed mild eosinophilia (61%), sparse lymphocytosis (83%) and mild neutrophilic infiltration (64%). There were 1-2 mitoses per 10 high power field in 12 cases (25.5%). No abnormal mitoses were identified. The presence of cells with features of Langerhans cells associated with the expression of selected immunohistochemical markers allow the diagnosis of LCH on cytological samples, sparing more invasive procedure as a biopsy.