Pediatric emergency medicine trisk 0950 0950

Treatment with antibiotics is necessary if the sinus or cyst is infected. Excision of
the entire tract and cyst is important to prevent recurrence.
Cystic hygromas are lymphatic malformations occurring in the posterior
triangle of the neck. Many are identified at birth, and 90% present before a child’s
second birthday. These may be recognized only after “herniation” has occurred,
generally, following injury, URI, crying, coughing, or other forceful Valsalva
maneuvers. Though variable in size, these discrete lesions are compressible,
mobile, nontender, and may transilluminate. Infection and airway compromise are
rare, and additional signs would be as expected. US is useful in confirming its
cystic nature. Chest radiograph is recommended to evaluate for extension into the
mediastinum with resultant chylothorax or chylomediastinum. Computed
tomography (CT) or magnetic resonance imaging (MRI) can determine the extent
and involvement of surrounding structures. Spontaneous regression is rare;
therefore, complete excision is the treatment of choice for small lesions. Larger
lesions may need intralesional sclerotherapy.
Hemangiomas (including capillary, strawberry, and capillary-cavernous
subtypes) are common vascular malformations of the head and neck, with a threeto-one female predominance. Generally noticed during a period of rapid growth
over the first year of life, these subsequently involute over the next several years.
These lesions are bluish or reddish in color, and may exhibit increased warmth, a
thrill or bruit, and capillary refill noted after palpation. They are otherwise soft,
mobile, and nontender to palpation. Lesions in the beard distribution may be
accompanied by glottic or subglottic hemangiomas, with an associated risk for
airway compromise. Other rare complications include thrombocytopenia from
platelet consumption, disseminated intravascular coagulation, hemorrhage,
congestive heart failure, ulceration, infection, and necrosis. Treatment for most
hemangiomas is conservative and nonoperative because the issues are almost
solely cosmetic and short term. Decisions about other treatments (corticosteroids,
β-blockers, laser treatment, intralesional sclerotherapy, and resection) are best
reserved for the pediatric surgeon or vascular malformation subspecialist.
Neonatal torticollis, often caused by fibromatosis colli (also called
sternocleidomastoid tumor), results from sternocleidomastoid fibrosis and

shortening of the muscle. Presenting symptoms of torticollis occur in the first 3
weeks of life, with the infant holding his/her head tilted toward the fibrous mass,
but face and chin tilted away from the affected side. Palpation reveals a firm mass
apparently adherent to the muscle. Physical therapy, including massage, range-ofmotion exercises, stretching exercises, and positional changes, is the preferred