45 year old female with cavernous hemangioma

 UNIT 4 ADMISSION 

45 YR OLD FEMALE CAME TO THE CASUALTY WITH 

C/O swelling in occipital region 6 yrs back 1 x 1 cms now it is 6 x 5 cms , progressive not a/w pain 

C/O back pain since 4 days 

C/O foreign body sensation while swallowing since 4 days 

C/O pain in epigastric region since 4 days 

C/O head ache in frontal region (b/l) since 4 months 

HOPI:

patient was apparently assymptomatic 6 yrs back ,then she developed swelling in occipital region which was 1x 1 cms ,then it gradually progressed to present size of 6 x 5 cms swelling was not a/w pain 

back pain ( on and off ) since 4 days 

Pain in epigastric region since 4 days ,a/w tenderness

Pain is intermittent and no aggravating and relieving factors 

Patient is K/C/O HTN since 1 week ( not taking any medication) 

Not a k/c/o DM,ASTHMA,TB

O/E 

PT IS C/C/C 

No pallor ,Icterus,cyanosis,clubbing

Parotid swelling present 

Vitals on admission : 

BP: 160/100 mmHg 

PR- 62 BPM 

RR- 17 cpm 

SPO2- 98 @ ROOM AIR 

CVS: S1S2 HEARD ,NO MURMERS

RS: BAE +,NVBS 

P/A: SOFT, TENDER IN EPIGASTRIC REGION 

CNS : 

B/L exaggerated reflexes of B,T,S,K,A 

P- mute 

Tone : normal in b/l ul nd ll  

Power : 5/5 in B/L UL and LL

Diagnosis : INTRAMUSCULAR HEMANGIOMA NECK, i.e. in BETWEEN TRAPEZIUS, SPLENIUS CAPITIS WITH NO INTRACRANIAL EXTENSION.

Treatment:

Tab. Pan 40mg  po OD 

Tab. Ultracet 1/2tab qid

Tab. MVT po OD 

On12/11/21:

On 14/11/21:

Soap notes ward case 

45 year old female 

S

c/o pain in neck region since 1 week 

difficulty in swallowing since 3 days 

O 

BP: 160/100 mmHg 

PR: 78 BPM 

Temp: 98.2°F 

CVS: S1S2 heard 

P/A: soft and non tender 

RS: BAE + ,NVBS 

A

Cavernous hemangioma in neck region 

P

T.MVT PO/OD

T PANTOP PO/OD (BBF)

On 15/11/21:

Soap notes ward case 

45 year old female

S: 

Difficulty in swallowing +

O 

BP: 140/90 mmHg 

PR: 78 BPM 

Temp: 98.2°F 

CVS: S1S2 heard 

P/A: soft and non tender 

RS: BAE + ,NVBS 

A

Cavernous hemangioma in neck region 

P

T.MVT PO/OD

T PANTOP PO/OD (BBF)

Planning for surgical opinion 

ENT REFERREL DONE I/V/O DYSPHAGIA:

On 16/11/21:

45 year old female 

S

 C/o foreign body sensation on swallowing

O 

BP: 130/90 mmHg 

PR: 78 BPM 

Temp: 98.2°F 

CVS: S1S2 heard 

P/A: soft and non tender 

RS: BAE + ,NVBS 

A

Cavernous hemangioma in neck region 

P

T.MVT PO/OD

T PANTOP PO/OD (BBF)

T.Flunarizine

Planning for upper GI endoscopy, and IDL

Bp charting 4th hrly

Upper GI endoscopy:

IDL: