Deniz Hassan is a Plastic Surgery Registrar in Merseyside. He is working as a plastic surgeon in Countess of Chester Hospital, United Kingdom.This topic willbe presented by Ms Rong.
Abstract
Curious ‘lumps and bumps’ are common in the plastic surgery outpatient clinic, with clinical diagnosis formulated from a good history and clinical examination. Simple lipomas account for the vast majority of these cases in the outpatient setting however atypical presentation can be puzzling for the clinician. The following case presented a diagnostic challenge emphasizing the role of an experienced clinician and an MDT approach in questioning the results of investigations which are at odds with the clinical examination. Ultrasound, CT scan and MRI results were deceptive in this case as revealed by the lack of demonstrable correlation with the clinical findings. The case also highlights the need for appropriate tissue diagnosis. In this case, a ‘trucut’ biopsy established a tissue diagnosis without interfering with any potential future management plans. The presented case was diagnosed as lipoma by radiology, only to prove to be Lymphoma on histological diagnosis. We pay particular attention to the role of ultrasound and tissue diagnosis in the work up for lipomas and unusual subcutaneous lumps.The case study looks at the principles in decision making in a plastic surgery clinic. It is important that a clinician is aware of the sensitivity and specificity of examinations ordered (1 and 2). This case study highlights the limitations of Ultrasound and the need for a clinician to use their experience in interpreting results and ordering relevant investigations in an MDT forum.
