53 year old with C/O swelling of back of neck 7 years and right thigh since 5 years. 2023
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53 year old male presented to the opd with C/O swelling of back of neck 7 years and right thigh since 5 years.
HOPI : Patient was apparently asymptomatic 7 yrs back then he developed swelling in back of neck which was insidious in onset gradually progressed to progressed to present size.
5 years back he had H/o trauma + (?wooden stick injury)
6 months later he noticed the swelling Initially started on the right side and progressed to involve first the lateral part for 2 years then progressed to medial part of the thigh also
On prolonged activity there is a little bit increase in size of the swelling with tightening of overlying skin
No pain or restriction of movements
PASTILLNESS
N/K/C/O Epilepsy HTN DM CAD CVA TB Asthma
Personal history:
Normal appetite takes veg diet (non veg stopped 2 years ago).He is a garment shop owner, regular bowel habits , normal micturition , no allergies and addictions.
Family History:
Father has hypertension
GENERAL PHYSICAL EXAMINATION
Patient conscious coherent cooperative
Moderately built and nourished
No, icterus, cyanosis, clubbing,pallor,edema,lymphadenopathy
Vitals:
Bp:130/90mmhg
RR-16cpm
PR-98 bpm
TEMP-98.1F
Cardiovascular System : S1, S2 heard, no murmurs
Respiratory System : Bilateral air entry present.Normal vesicular breath sounds heard.Position of trachea central.
Central Nervous System : patient is conscious coherent and cooperative. Higher mental functions intact
Per abdomen : soft, non tender ,no guarding and rigidity
LOCAL EXAMINATION:
INSPECTION:
A single swelling over Right Thigh region of size 20*15 cm and of elliptical shape.No discharge from the swelling,no visible pulsations dilated veins scars sinuses seen.
No redness, skin over the swelling is shiny.
PALPATION:
No local rise of temperature or tenderness.
All inspectory finding are confirmed
A single swelling over Right Thigh region of size 20*15 cm and of elliptical shape and cystic in consistency.Surronding skin is normal. All borders are well defined and swelling non mobile in all directions.skin over the swelling is pinchable.
INSPECTION:
A single swelling over back of neck region of size 4x4 cm and of oval shape.No discharge from the swelling,no visible pulsations dilated veins scars sinuses seen.
No redness, skin over the swelling is Normal.
PALPATION:
No local rise of temperature or tenderness.
All inspectory finding are confirmed
A single swelling over back of neck region of size 4x 4 cm and of ovoid shape and soft in consistency.Surronding skin is normal. All borders are well defined and swelling non mobile in all directions.skin over the swelling is pinchable
Provisional Diagnosis:
Lipoma over the nape of neck
Swelling over Rt thigh ?Lipoma
of the Right Thigh
Orthopaedics referral was done i/v/o any bony involvement and xray was advised which was normal
General Surgery opinion was taken i/v/o liposarcoma and true cut biopsy was adviced and done on 22/2/23
the patient was asked to report to General Surgery OPD with biopsy reports
Management :
Tab.Dolo 650 mv sos
Tab.MVT po/od
Tab Vit C po/od
Advice at discharge:
T.MVT po/od x 15 days @2pm
Follow up:
Report to General Medicine OPD and General Surgery OPD with biopsy reports after 1 week
26/04/23
Patient came for follow up and for biopsy
Oncosurgeon advise was taken
Usg guided multiple trucut biopsies targetng specific areas to be recommended.
Incision biopsy in soft tissue tumour is not advisable; to avoid gross tumor spill into intramuscular planes and subcutaneous tissue which would compromise limb conserving compartmental resection later
27/04/23
S:
Swelling not reduced in size
O:
Patient is conscious,coherent,cooperative
Temp:98.6°F
BP:120/90mmhg.
PR:68bpm.
RR:18cpm.
CVS:S1,S2HEARD ,NO MURMURS.
RS:BAE+,NVBS.
Abdomen: soft , non tender
CNS : NFND
A :
Swelling of right thigh? Lipoma ? Liposarscoma
P:
Tab MVT PO / OD
Vitals monitoring 6 th hourly
28/04/2023
S:
Swelling not reduced in size
O:
Patient is conscious,coherent,cooperative
Temp:98.4°F
BP:130/90mmhg.
PR:78bpm.
RR:18cpm.
CVS:S1,S2HEARD ,NO MURMURS.
RS:BAE+,NVBS.
Abdomen: soft , non tender
CNS : NFND
A :
Swelling of right thigh? Lipoma ? Liposarscoma
P:
Tab MVT PO / OD
Vitals monitoring 6 th hourly
29/04/2023
27/04/23
S:
O:
Patient is conscious,coherent,cooperative
Temp:98.6°F
BP:140/80mmhg.
PR:74bpm.
RR:16cpm.
CVS:S1,S2HEARD ,NO MURMURS.
RS:BAE+,NVBS.
Abdomen: soft , non tender
CNS : NFND
A :
Swelling of right thigh? Lipoma ? Liposarscoma
P:
Tab MVT PO / OD
Vitals monitoring 6 th hourly
