Clinical Tropical Medicine 
Christian Medical College, Vellore, Tamilnadu, India

History:

Master A 11 year old male child resident of Tamilnadu, presented with history of swelling on the right forearm for the past three months.  He also had throbbing pain around the swelling causing difficulty in performing school activities efficiently especially writing. He says swelling has not changed in size significantly. No history of associated diarrhoea/trauma/fever/loss of hearing/seizures. No history of similar swelling elsewhere on body. No history of weight loss.

He has been operated in the past in our hospital for penoscrotal hypospadias (urethroplasty) in 2011

On examination:

No pallor, lymphadenopathy rash or similar swellings elsewhere on the body.

 Right forearm: 3x4 cm firm cystic swelling on the extensor aspect of the right hand with surrounding erythema and minimal mobility. No distal neurovascular deficits

Systemic examination was otherwise unremarkable

Possible differential diagnosis for subcutaneous single nodule on forearm

  1. Neurofibroma
  2. Osteoid osteoma
  3. Leiomyosarcoma
  4. Deep fungal infections: phaeohyphomycosis
  5. Parasitic muscle cyst
  6. Cysticercosis
  7. Trichinella spiralis

Investigations:

CRP                                        <3.19          mg/L        (<6)

WBC Total                             12100          /CU MM         

WBC Differential                                                        

Neutrophils                               58             %                       

Eosinophils                                4              %             

            Basophils                                   0              %             

            Lymphocytes                           31             %             

            Monocytes                                 7             %             

 

            ESR 60'                                   14             MM            

 

Chest Xray

 

					Chest Xray - Normal 

 

Xray Elbow

US Extremities

 

A  11.7  x  7.8  mm  cystic  lesion  noted  in  the  dorsum  of  the  right  forearm  ulnar  side  in  close  association  with  the  muscle  on  the  ulnar  side  (  likely  extensor  carpi  ulnaris)  the  cyst  shows  a  central  curvilinear  solid  structure-  likely  scolex

 

 

Click here for Diagnosis and Discussion

 

 

 

 

 

 

AP and lateral views: Soft tissue swelling noted, no beny involvement, no cigare shaped calcifications seen