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CASE 2: ENT. General Data. J.Y. 13 y/o Female Single Filipino Roman Catholic from Butuan City, Agusan del Norte. Chief Complaint. Enlarged tongue. Px born to a 23 y/o primigravid via NSD at a tertiary hospital

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general data
General Data
  • J.Y.
  • 13 y/o Female
  • Single
  • Filipino
  • Roman Catholic
  • from Butuan City, Agusan del Norte
chief complaint
Chief Complaint
  • Enlarged tongue
history of present illness

Px born to a 23 y/o primigravid via NSD at a tertiary hospital

  • (+) prenatal check-up, denies any exposure to radiation/ intake of teratogenic drugs
  • Admitted at a local hospital due to swelling and bleeding of tongue.
  • Given unrecalled antibiotics.
  • Advised to transfer to another hospital but px did not comply due to lack of funds.
  • Mother noted spontaneous resolution of tongue swelling.
  • Noted by the attending physician to have enlarged tongue.
  • No medications given, no further consultation advised.
  • (-) Difficulty feeding, dyspnea, snoring
History of Present Illness
  • OB Hx
  • 12 years PTA
  • 13 years PTA
history of present illness1

Persistence of symptoms led to consult with a private ENT in Davao

  • (+) progressive enlargement of the tongue
  • (+) episodes of bleeding and swelling of the tongue 3-4x/ year.
  • Px would seek consult with MD and unrecalled antibiotics were given.
History of Present Illness
  • 3 years PTA
  • Interval history (1997-2007)
history of present illness2

(+) persistent bleeding and swelling of tongue

  • (+) pain on the anterior 1/3 of the tongue.
  • Can only tolerate minced and soft foods.
  • Noted to be pale and weak by the mother.
History of Present Illness
  • 2 months PTA

ADMISSION

review of systems
Review of Systems
  • (-) weight loss
  • (-) skin rashes, changes in pigmentation
  • (-)blurring of vision, headache
  • (-) decreased hearing sensation, tinnitus, dizziness
  • (-)cough and colds, chest pains, palpitations
  • (-)abdominal pain, changes in bowel/bladder function
  • (-)edema, joint pains, muscle pains
past medical history
Past Medical History
  • (-) allergies
  • (-)PTB
  • (-) hepatitis
  • (-) asthma
  • (-) previous surgeries and blood transfusions
menstrual and obstetric history
Menstrual and Obstetric History
  • Menarche – 12 y/o
  • Irregular period
  • Duration: 4-5 days
  • Amount: 5 pads/day
  • Symptoms – dysmenorrhea
family history
Family History
  • (-) HPN
  • (-) DM
  • (-) Asthma
  • (-) PTB
  • (-) Ca
  • (-) Down’s Syndrome
personal and social history
Personal and Social History
  • H – has good relations with other family members and persons at home
  • E – 1st year high school, average student
  • A – enjoys watching TV and DVD
  • D – no hx of illicit drug use, smoking, intake of alcoholic beverages
  • S – has few friends, rarely goes out
  • S – no sexual activity
physical examination
Physical Examination
  • Weight – 39 kg
  • Height – 144 cm
  • BMI – 20
  • BP – 100/70
  • PR – 84 bpm
  • RR – 22c pm
  • T – 36.7
physical examination1
Physical Examination
  • Height for age – normal; Z score below -1
  • BMI for age – normal; Z score 0 (median)
  • Conscious, coherent, ambulatory, not in cardiorespiratory distress
  • Warm moist skin, no rashes
  • Anicteric sclera, pink palpebral conjunctivae
physical examination2
Physical Examination
  • Symmetric chest expansion, clear breath sounds
  • Adynamicprecordium, AB at 5th LICS MCL, no murmurs, no thrills
  • Flat abdomen, NABS, soft, nontender
  • Full and equal pulses, no swelling, no edema
  • SMR = 3
ent examination
ENT Examination
  • Anterior rhinoscopy: midline septum, turbinates not congested, no nasal polyps
  • Oral cavity: (+) enlarged reddened tongue; (+) multifocal, pebbly, vesicle like lesions on the tip, dorsal and lateral surfaces of the anterior 1/3 of the tongue; (+) blood clots on dorsal and ventral surface of anterior 1/3 of tongue; moist buccal mucosa
ent examination1
ENT Examination
  • Pharynx – nonhyperemic posterior pharyngeal wall, tonsils not enlarged
  • Otology: AD – no tragal tenderness, nonhyperemic EAC, intact TM; AS – no tragal tenderness, nonhyperemic EAC, intact TM
  • Face and neck: no facial asymmetry, neck masses, thyromegaly, palplable lymph nodes
neurologic examination
Neurologic Examination
  • conscious, coherent, oriented to 3 spheres;
  • pupil 2-3 mm ERTL, EOMs full and equal
  • can clench teeth, can raise eyebrows, can close eyes tightly, can smile, can frown
  • no hearing loss, limited side to side head turning, tongue midline on protrusion
  • can do FTNT and APST
  • MMT 5/5 on all extremities
  • DTR ++ on all extremeties
  • no sensory deficits
what is your impression of the case

MacroglossiaSecondary to

Lymphangiomaof the Tongue

Guide Question 1

What is your impression of the case?
what laboratory exams would you recommend

Biopsy of the Tongue

Thyroid assays

Imaging Studies: CT Scan, MRI of the Head & Neck

Guide Question 2

What laboratory exams would you recommend?
slide23

Biopsy of the tongue

  • Thyroid function test – to rule out hypothyroidism
  • Imaging Studies – to determine extent of lesion and pre-operative planning
    • CT Scan
    • MRI – test of choice
put your discussion1
PUT YOUR DISCUSSION
  • No proven medical care for lymphangiomasexists. This condition is not responsive to radiation therapy or steroids.
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