You are correct. The pt had facial purpura caused by emesis, which ruptured capillaries in the upper dermis due to elevated intravascular pressure. This occurs after severe straining, such as from vomiting, prolonged coughing, crying, infant delivery, or any effort involving the Valsalva maneuver. Facial purpura has also been reported as a complication of endoscopic procedures. The condition is related to the rich vascular supply to the face and tends to occur at particular sites of loose tissue, such as the eyelids. Lab tests and skin biopsies are not needed.

BMJ 2017;358:j3148

You are correct. Poland syndrome is a developmental anomaly characterized by hypoplasia of the sternocostal head of the pectoralis major, ipsilateral digit abnormalities (such as brachydactyly or syndactyly), and nipple/breast and other chest wall and scapula abnormalities. The etiology is unclear, but is thought to be secondary to vascular defect of the subclavian artery during the 6th week of gestation. Tx is primarily reconstructive surgery, depending on the severity of the malformation, gender, and pt preference. Generally, the reconstructive path is complex and must be performed stepwise because the malformation involves alteration of different tissues (skin, subcutaneous tissue, muscle, and breast). Reconstructive surgery is planned for this pt after he finishes growing.

BMJ Case Reports 2017; doi:10.1136/bcr-2017-221564