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Abstract

The extremely rare localization of an intramuscular hemangioma (IMH) into the anterior scalene muscle was the motive for the present case report, aiming to highlight major, atypical characteristics. An 11-month-old boy with free medical history presented with a painless and progressively growing lesion 4.5 × 4 cm in diameter, located in the left supraclavicular region over the last 4 months. During physical examination, the presence of a painless, non-pulsating, non-adhesive to the overlying skin lesion was documented. Color Doppler flow ultrasonographic examination demonstrated the increased blood supply to the aforementioned lesion. Thus, we planned an elective surgical excision of the lesion in healthy limits. The postoperative course was uneventful, and the patient was discharged on the second postoperative day in good general condition. Histopathologic examination revealed the presence of hemangioma surrounded by connective tissue bundles and striated muscle fibers. IMHs do not follow the general rule of regression, beyond the age of 6–12 months, with no trend to increase over time. Accurate preoperative diagnosis is challenging. Color Doppler flow ultrasonographic examination is the imaging modality of choice during the preoperative assessment. Surgical excision of the IMH in healthy limits is the most appropriate treatment option.
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Authors and Affiliations

Ioannis Patoulias
1
Ioanna Gkalonaki
1
ORCID: ORCID
Magdalini Mitroudi
1
Thomas Feidantsis
1
Constantine Theocharidis
2
Dimitrios Patoulias
3

  1. First Department of Pediatric Surgery, Aristotle University of Thessaloniki, General Hospital “G. Gennimatas”, Greece
  2. Department of Pathology, General Hospital “G. Gennimatas”, Thessaloniki, Greece
  3. Second Propedeutic Department of Internal Medicine, Aristotle University of Thessaloniki, General Hospital “Hippokration”, Greece
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Abstract

An 11-year old boy presented with a blunt trauma in the right inguinal area after a bicycle accident. Initial clinical picture was indicative of decreased arterial blood supply to the right lower extremity and the diagnostic confirmation was made with a colour flow Doppler ultrasonography. During operative investigation, a thrombosis of the common femoral artery, 3.5 cm in length, was found. The thrombotic part of the femoral artery was removed and replaced with a venous graft taken from the major saphenous vein, before the saphenofemoral junction. Postoperative course was uneventful. Traumatic thrombosis of the common femoral artery as a result of a blunt trauma is very rare, as only 4 relevant cases have been described previously.
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Bibliography

1. Corneille M.G., Gallup T.M., Villa C., et al.: Pediatric vascular injuries: acute management and early outcomes. J Trauma. 2011; 70: 823–828.
2. Allison N.D., Anderson C.M., Shah S.K., et al.: Outcomes of truncal vascular injuries in children. J Pediatr Surg. 2009; 44: 1958–1964.
3. Mommsen P., Zeckey C., Hildebrand F., et al.: Traumatic extremity arterial injury in children: epidemiology, diagnostics, treatment and prognostic value of Mangled Extremity Severity Score. J Orthop Surg Res. 2010; 5: 25.
4. Sarfati M.R., Galt S.W., Treiman G.S., Kraiss L.W.: Common femoral artery injury secondary to bicycle handlebar trauma. J Vasc Surg. 2002; 35: 589–591.
5. Conrad M.F., Patton J.H. Jr., Parikshak M., Kralovich K.A.: Evaluation of vascular injury in penetrating extremity trauma: angiographers stay home. Am Surg. 2002; 68: 269–274.
6. Harris L.M., Hordines J.: Major vascular injuries in the pediatric population. Ann Vasc Surg. 2003; 17: 266–269.
7. Hossny A.: Blunt popliteal artery injury with complete lower limb ischemia: is routine use of temporary intraluminal arterial shunt justified? J Vasc Surg. 2004; 40: 61–66.
8. Milas Z.L., Dodson T.F., Ricketts R.R.: Pediatric blunt trauma resulting in major arterial injuries. Am Surg. 2004; 70: 443–447.
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Authors and Affiliations

Ioannis Patoulias
1
Ioannis Panopoulos
2
Georgios Pitoulias
3
Thomas Feidantsis
1
Dimitrios Patoulias
4

  1. First Department of Pediatric Surgery, Aristotle University of Thessaloniki Greece, General Hospital “G. Gennimatas”, Greece
  2. Department of Pediatrics, General Hospital “G. Gennimatas”, Thessaloniki, Greece
  3. Department of Vascular Surgery, Aristotle University of Thessaloniki Greece, General Hospital “G. Gennimatas”, Greece
  4. Second Propedeutic Department of Internal Medicine, Aristotle University of Thessaloniki, General Hospital “Hippokration”, Greece

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