(BMJ)—A 12-yo boy w/ hx of mild recurrent iron deficiency presented w/ discoloration on his chin; a similar episode occurred several months prior. He denied any trauma. Exam: circumscribed, bluish purple, nontender discoloration on chin. Labs: WNL. What is the dx?
Blue rubber bleb nevus syndrome
Vacuum hematoma
Nevus of Ota
Cavernous hemangioma
Shaving injury
You are correct. When specifically asked, the boy remembered vacuum-sucking a glass to his chin and forcefully removing it. DDx of a bluish purple discoloration ranges from mild to potentially severe underlying dz. Bruises are common in children and usually assoc w/ minor injury. However, underlying hemostatic abnormalities and nonaccidental injuries need to be considered. This case illustrates that “out-of-the-box” thinking and empathy into a child’s life are also necessary for the pediatrician to make a correct dx.

Arch Dis Child doi:10.1136/adc.2010.182717