Case for Diagnosis
Frontal Tumor That Increased in Size With the Valsalva Maneuver
Tumoración frontal que aumenta de tamaño con maniobra de Valsalva
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The patient denied trauma in the area and was in good general health.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Physical Examination</span><p id="par0010" class="elsevierStylePara elsevierViewall">Physical examination showed a firm, fixed lesion that was pulseless on palpation in the right frontal region (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Additional Tests</span><p id="par0015" class="elsevierStylePara elsevierViewall">Based on the initial clinical suspicion of an epidermoid cyst or frontal lipoma, we performed a skin ultrasound examination using a linear transducer with a variable frequency of 10 to 22<span class="elsevierStyleHsp" style=""></span>MHz. Scanning of the dermis-hypodermis in the longitudinal axis showed a well-delimited, hypoechogenic ovoid lesion with a diameter of 5<span class="elsevierStyleHsp" style=""></span>mm with posterior reinforcement and an edge shadowing artifact. On the longitudinal axis, the lesion had a uniform, fusiform morphology.</p><p id="par0020" class="elsevierStylePara elsevierViewall">Color Doppler ultrasound showed vascularization in the center of the lesion (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). Pulsed-wave Doppler showed turbulent flow. The patient was asked to perform the Valsalva maneuver during the examination and we observed a noticeable increase in velocity in the Doppler spectrum (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>).</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">What Is Your Diagnosis?</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Diagnosis</span><p id="par0030" class="elsevierStylePara elsevierViewall">Frontal phlebectasia.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Clinical Course and Treatment</span><p id="par0035" class="elsevierStylePara elsevierViewall">The lesion was surgically removed through ligation and excision. Complete excision was confirmed by ultrasound and a histologic examination was performed.</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Comment</span><p id="par0040" class="elsevierStylePara elsevierViewall">A phlebectasia is a saccular or fusiform dilatation of a vein without tortuosity. The clinical presentation is generally that of a round, painless, pulseless mass with a smooth contour that does not affect the skin surface.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a> Phlebectasias become apparent or grow in size with strain, crying, sneezing, coughing, or the Valsalva maneuver, and disappear or decrease in size when the patient is calm.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">Most cases of phlebectasia of the head and neck in the literature have involved the jugular vein.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a> Jugular vein ectasia has been associated with connective tissue disorders, such as Menkes disease.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">4</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">Diagnosis by ultrasound tends to show a fusiform dilatation of the affected vein and changes in size during the Valsalva maneuver. The ratio between size at rest to size during the maneuver is approximately 1.5 to 2:1.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">5</span></a> Ultrasound can also be used to investigate thrombi and response to external compression. Color Doppler flow imaging shows turbulent vascular flow in the affected segment.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">5</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">Procedures such as fine needle aspiration and drainage should be avoided in phlebectasia due to the risk of complications.</p><p id="par0060" class="elsevierStylePara elsevierViewall">Lesion growth and potential complications can be monitored by ultrasound. Surgery is indicated in cases of thrombi, phlebitis, aesthetic deformity, and rupture.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">5</span></a></p><p id="par0065" class="elsevierStylePara elsevierViewall">We believe that phlebectasia of the head and neck is underdiagnosed and ultrasound skin imaging is very useful for diagnosis, evaluation of complications, and postsurgical and longer-term follow-up. The present case also shows that systematically using color Doppler to study dermatological lesions is a valuable technique for establishing a correct diagnosis.</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Conflicts of Interest</span><p id="par0070" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:8 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Medical History" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Physical Examination" ] 2 => array:2 [ "identificador" => "sec0015" "titulo" => "Additional Tests" ] 3 => array:2 [ "identificador" => "sec0020" "titulo" => "Diagnosis" ] 4 => array:2 [ "identificador" => "sec0025" "titulo" => "Clinical Course and Treatment" ] 5 => array:2 [ "identificador" => "sec0030" "titulo" => "Comment" ] 6 => array:2 [ "identificador" => "sec0035" "titulo" => "Conflicts of Interest" ] 7 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Catalán Griffiths A, Alfagueme Roldán F, Salgüero Fernández I, Ragusa MG. Tumoración frontal que aumenta de tamaño con maniobra de Valsalva. Actas Dermosifiliogr. 2019;110:e7–e8.</p>" ] ] "multimedia" => array:3 [ 0 => array:6 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 601 "Ancho" => 600 "Tamanyo" => 63602 ] ] ] 1 => array:6 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 673 "Ancho" => 789 "Tamanyo" => 82832 ] ] ] 2 => array:6 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 764 "Ancho" => 867 "Tamanyo" => 104947 ] ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0030" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Flebectasia de la vena yugular interna" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "J. 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"fecha" => "2016" "volumen" => "68" "paginaInicial" => "367" "paginaFinal" => "369" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27508141" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0045" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Focal ectasia of internal jugular vein" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "H. Swami" 1 => "S. Nambiar" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/S0377-1237(09)80029-4" "Revista" => array:6 [ "tituloSerie" => "Med J Armed Forces India." 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| año/Mes | Html | Total | |
|---|---|---|---|
| 2024 Noviembre | 11 | 10 | 21 |
| 2024 Octubre | 68 | 65 | 133 |
| 2024 Septiembre | 53 | 31 | 84 |
| 2024 Agosto | 90 | 77 | 167 |
| 2024 Julio | 64 | 31 | 95 |
| 2024 Junio | 75 | 28 | 103 |
| 2024 Mayo | 56 | 28 | 84 |
| 2024 Abril | 64 | 30 | 94 |
| 2024 Marzo | 61 | 28 | 89 |
| 2024 Febrero | 70 | 45 | 115 |
| 2024 Enero | 57 | 36 | 93 |
| 2023 Diciembre | 55 | 21 | 76 |
| 2023 Noviembre | 56 | 34 | 90 |
| 2023 Octubre | 47 | 28 | 75 |
| 2023 Septiembre | 41 | 29 | 70 |
| 2023 Agosto | 41 | 13 | 54 |
| 2023 Julio | 44 | 35 | 79 |
| 2023 Junio | 43 | 25 | 68 |
| 2023 Mayo | 43 | 25 | 68 |
| 2023 Abril | 31 | 18 | 49 |
| 2023 Marzo | 58 | 23 | 81 |
| 2023 Febrero | 36 | 23 | 59 |
| 2023 Enero | 37 | 28 | 65 |
| 2022 Diciembre | 59 | 33 | 92 |
| 2022 Noviembre | 44 | 27 | 71 |
| 2022 Octubre | 30 | 25 | 55 |
| 2022 Septiembre | 32 | 40 | 72 |
| 2022 Agosto | 33 | 55 | 88 |
| 2022 Julio | 31 | 40 | 71 |
| 2022 Junio | 35 | 32 | 67 |
| 2022 Mayo | 38 | 29 | 67 |
| 2022 Abril | 36 | 23 | 59 |
| 2022 Marzo | 46 | 51 | 97 |
| 2022 Febrero | 38 | 18 | 56 |
| 2022 Enero | 46 | 39 | 85 |
| 2021 Diciembre | 31 | 28 | 59 |
| 2021 Noviembre | 31 | 34 | 65 |
| 2021 Octubre | 49 | 44 | 93 |
| 2021 Septiembre | 41 | 31 | 72 |
| 2021 Agosto | 26 | 26 | 52 |
| 2021 Julio | 27 | 23 | 50 |
| 2021 Junio | 21 | 29 | 50 |
| 2021 Mayo | 28 | 32 | 60 |
| 2021 Abril | 57 | 57 | 114 |
| 2021 Marzo | 46 | 20 | 66 |
| 2021 Febrero | 35 | 29 | 64 |
| 2021 Enero | 19 | 19 | 38 |
| 2020 Diciembre | 17 | 9 | 26 |
| 2020 Noviembre | 19 | 15 | 34 |
| 2020 Octubre | 23 | 21 | 44 |
| 2020 Septiembre | 27 | 9 | 36 |
| 2020 Agosto | 18 | 17 | 35 |
| 2020 Julio | 10 | 14 | 24 |
| 2020 Junio | 26 | 20 | 46 |
| 2020 Mayo | 14 | 11 | 25 |
| 2020 Abril | 18 | 11 | 29 |
| 2020 Marzo | 13 | 7 | 20 |
| 2020 Febrero | 3 | 0 | 3 |
| 2019 Octubre | 1 | 0 | 1 |
| 2019 Marzo | 1 | 0 | 1 |
| 2019 Febrero | 103 | 0 | 103 |
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