Module 44, Pediatric Orthopaedist Level
A 6 year old female presented to Outpatient Clinic with mass in her
left foot which the mother says has been getting bigger and causes pain
when the child walks for more than a few steps. There was firm tender mass
within the planter arch area of the left foot. the mass was approximately
6.5 x l7 cm. It involved virtually the entire arch of the foot. An xray
was obtained which demonstrated normal bones and no calcification in the
soft tissues. Further history demonstrated that she had an excision biopsy
of mass of the left foot. Intra-operative finding revealed a fatty vascular
tumor at the planter aspect of the medial left foot which was infiltrative
and adherent to the medial plantar artery the medial planter nerve, the
flexor hallucis longus as well as the flexor tendon of the second, third,
and fourth toes. The pathology report was a benign lesion. She then was
followed 3 months later with a lower extremity arteriogram with transcatheter
embolisation of left foot arteriovenous malformation. The current MRI is
above.
Question 44A
This
lesion is not likely a capillary hemangioma because it is easy to palpate.
Question 44B
This
lesion is a benign stage three lesion because it crosses multiple compartments
in the foot.
Question 44C
In
an aggressive stage 3 benign lesion, foot amputation should be considered
as a primary option.
Question 44D
All
biopsies of the foot should be performed through a longitudinal incision.
Question 44E
The
MRI is the most specific study to define the borders of a hemangioma for
which surgical excision is planned.
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