(BMJ)—A healthy 15-mo girl was brought in w/ a 2-day hx of a painless lump in the vagina. The parent reported that it protruded or receded into the vagina during diaper changes. No hx of trauma/bleeding/drainage. Review of systems negative. Exam: 2.5-cm lobular mass on L vaginal wall. What is the dx?
Human papillomavirus lesion
Urethral prolapse
Gartner duct cyst
Rhabdomyosarcoma
Foreign body
You are correct. MRI and excisional bx confirmed the dx of sarcoma botryoides, a subtype of rhabdomyosarcoma. Typically, urethral prolapse demonstrates donut-shaped eversion, HPV causes verrucous lesions, and foreign bodies have variable forms w/ foul or bloody d/c. Masses w/ irregular borders raise the probability of malignancy, unlike round, well-circumscribed masses, which are typically benign. Rhabdomyosarcoma is the most common pediatric vaginal tumor. Early detection is critical because early tx extends 5-yr survival for this rapidly progressing mass to over 90%.

Emergency Medicine Journal 2019;36:464-492
By vgreene, 29 August, 2019

aIIV3

(BMJ)—A 32-yo woman w/ a past hx of DVT presented w/ a 2-day hx of gradually worsening periumbilical pain. She denied nausea, vomiting, diarrhea, or fever. Exam: periumbilical tenderness; dilated veins on chest and abdomen; both Murphy and McBurney signs were negative. Labs: CBC, LFTs, lipase, UA all WNL. Imaging confirmed the dx. What is it?
Antiphosopholipid syndrome
Superior vena cava syndrome
Mondor dz
Hypoplasia of inferior vena cava
Biliary tract tumor
You are correct. CT angiography of the chest and abdomen revealed portal vein thrombosis and marked hypoplasia of the inferior vena cava (IVC). Hypoplasia of the IVC is a rare congenital malformation assoc w/ VTE. This aplasia/hypoplasia is detected more often in young males and has been linked w/ factor V Leiden mutation. Dilated veins over the chest and abdomen can be a sign of chronic collateral circulation through the azygous and intercostal veins, induced by IVC hypoplasia. This dx should be considered in the differential of young pts w/ unexplained thromboembolic events and dilated chest and abdominal veins. Portal vein thrombosis was the most likely cause of the acute abdominal pain in this pt, and tx w/ anticoagulation was initiated.

Emergency Medicine Journal 2019;36:540-564.