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hi every one, was just wondering if any one would be able to shed some light on a case. a patient was referred to myself by her GP for treatment of a 'corn'. on assessment there was pain L1st lateral boarder of IPJ, a round shape, hard to touch ( felt kind of like a cyst) was red and turned cyanotic with touch. it obviously is not a corn but i dont see how it could be a ganglion/cyst. the patient reports having walked more than usual in the past week from which the pain started, so could it be a haematoma? just want to make sure that its not something more serious....

thanks :)
sarah
:craig:

 

Re: help?!

Hi Sarah,

Doesn`t look sinister to me. Remember your ABC when looking at suspicious lesions;

Asymmetry
Border
Colour
Diameter
Evolution (change)

A little more on med history would be grand. In particular:

• medication
• age of pt
• vascular status
• footwear whilst `walking more`

First impression, perniosis. However, it could well just be a haematoma.

http://old.dermnetnz.info/reactions/chilblains.html

Cheers,
Bel

 

Re: help?!

thanks for getting back to me!!:)
vascular system was found to be intact as well as neurological, pt is currently on no medications, the only thing that cropped up in medical history was an allergy to morphine but she hasn't been exposed to that at all recently. she wears a trainer when walking, however daily footwear isnt ideal. pt is mid 50's.
it has been very chilly in the IOM recently so that may explain alot!!

i would love to know what text book this GP is reading to say that looks like a corn. :bash:

:)

 

Re: help?!

The GP wouldn't have read any text book or even been that interested, thats what your there for.

Did it feel osseous? Potentially an exostosis?

George

 

Re: help?!

no it definitely didn't feel osseous! more like a fluid filled sac really!

sarah

 

It could be a hemangioma or some other vacular tumor if it blanches on pressure. I had a similar looking structure plantar 2nd webspace that didn't drain, opaque appearance on x-ray. MRI diagnosed it as hemangioma. I did a surgery to excise it and the patient is fine now. You might try to do a local injection around it w/ lidocaine or sensorcaine to see if it turns more red because local anesthesia can increase vascularity locally. Good luck

Dr. Dale

 

mild chilblains?

 

Isn`t that what I suggested? ;)

 

I'd tend to go along with Bel, but considering the heavy callous just proximal as diff diagnx you might consider a bursa or even (I know you had some doubts) a ganglionic cyst.

Let us know

All the best

Bill Liggins