(BMJ)—An 8-yo girl w/ hx of constipation presented w/ sudden onset of perineal bleeding during urination. There was no hx of trauma, fever, or dysuria. FHx: neg. Exam: red, doughnut-shaped lesion at urethral meatus. CBC and coagulation panel: normal. STD swabs: neg. What is the dx?
Urethral caruncle
Urethral prolapse
Urethral papilloma
Vaginal polyp
Nonaccidental trauma
You are correct. Urethral prolapse (UP) is an eversion of the distal urethral mucosa through the external meatus. It is most commonly seen in postmenopausal women and is uncommon in prepubertal girls. Increased abdominal pressure due to straining at stool is a possible contributing factor. Tx options include tepid water baths and topical estrogens. Surgery is indicated if bleeding, dysuria, or pain persist. This pt was treated w/ topical estrogen cream and oral polyethylene glycol for her constipation. On day 10, the bleeding stopped, and the UP had moderately regressed at 5wk. However, occasional mild bleeding persisted at 10mo, so she was referred to a urologist.

Archives of Disease in Childhood 2017;102:472.

(BMJ)—A 10-yo girl w/ no PMHx presented w/ a 2-wk hx of a small, reddish mass on her R upper eyelid. Her visual acuity and ocular exam were normal. The ≈2x2-mm mass, which was near her eyelashes, rapidly increased in size during the next 2wk. What is the dx?
Angiosarcoma
Kaposi sarcoma
Acquired tufted angioma
Dacryoadenitis
Acquired capillary hemangioma
You are correct. Acquired capillary hemangioma of the eyelid is rare. Cases occur around puberty and during pregnancy, probably due to hormonal changes, and in middle-aged men. In this pt, the lesion was surgically excised, w/ a good cosmetic result.

BMJ Case Reports 2017; doi:10.1136/bcr-2017-219777