Question of the Week # 53, 54

 4-month-old girl is brought by her concerned mother  because the child has been inconsolably crying for 6 hours. The child is breast fed and has been doing well. There is no vomiting, diarrhea, constipation, or increased gas. The mother has not changed her diet and the infant is on no medications. There has been no fever. On physical examination the child is active and screaming. There is no fever.  The physical examination is normal except that there is redness and swelling affecting the left  third toe with indentation proximal to the redness. It is tender to touch. There was no history of similar problems.  The picture is shown below: 

 

The most likely working diagnosis:

A. Trauma

B. Herpetic whitlow

C. Hairy tourniquet syndrome

D. Acute paronychia

E. Ingrown toe nail

F. Acute Gout

The most appropriate next step in management :

A. Joint aspiration

B. X-ray of the foot

C. Inspect the toe for hair strangulation

D. Incision and drainage

E. Topical acyclovir

10 Responses

  1. answer is c and c

  2. C and C

  3. E, D

  4. c &c

  5. c,c

  6. Wow C —-C

  7. C and C

    Postpartum hair loss can not only make a mess of a mother’s appearance and bathroom counters, but can cause the loss of her child’s extremities if she’s not careful.

    Hair tourniquet syndrome occurs when a hair becomes wrapped around a child’s appendage so tightly as to cut off circulation. Toes, fingers or genitals can be affected. The syndrome happens most often in the postnatal period when mothers experience increased hair loss. Occasionally a thread or fibre is the culprit.

    A typical presentation is a screaming baby with no obvious cause for complaint. Upon closer inspection, redness, tenderness and swelling of the affected area – most commonly the middle finger or toe – may be noted. Often the hair itself is no longer visible due to the swollen tissues around it, making it difficult to unwind or cut.

    Untreated, hair tourniquet syndrome can cause progressive swelling, ischemia (lack of oxygen) and tissue necrosis (death), and can cause autoamputation of the strangulated structure.

    Maybe there’s a legitimate reason for a mom haircut after all.

    Removal is indicated in all cases of hair or thread tourniquet syndrome and should be implemented as early as possible.
    Adequately visualized constricting bands with little or no tissue edema are good candidates for the unwrapping technique.
    Cases associated with mild to moderate edema are candidates for the blunt probe cutting technique.
    In cases where other techniques have failed, when the swelling is so severe that the constricting band is not visible, or when epithelialization has occurred, the incisional approach should be implemented.
    The use of depilatory creams is probably better suited for mild to moderate cases of hair tourniquet syndrome.

  8. Sounds good to me

  9. beautiful hair brings the beautiful death!!be careful with beautiful hair!!!!

  10. Is this tested on usmle?

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