Teeth are intact. Neck: Trachea midline, no masses or lymphadenopathy. Chest/Lungs: Lungs sound clear per auscultation bilaterally. Respiratory rate is regular, and even. No shortness of breath, accessory muscle use, or cough. Heart/Peripheral Vascular: S1, S2 noted. No murmur or gallops. Regular rhythm per auscultation. No peripheral edema. Abdomen: Soft, non-tender, no guarding, rounded, but non-distended. Active bowel sounds X4 quadrants. Genital/Rectal: deferred Musculoskeletal: Full range of motion in bilateral upper extremities and bilateral lower extremities. No joint swelling. Neurological: Cranial nerves II-XII intact. Sensory intact, strength 5/5, reflexes 2+ equal bilaterally. Gait is appropriate, well-balanced coordination. Skin: No edema, clubbing, or cyanosis to extremities. Skin turgor taut, appropriate for ethnicity, and dry. Multiple non-tender small ruby-red and many small purple, round papules and macules noted on the torso. ASSESSMENT Differential Diagnosis 1. Diagnosis: Cherry Hemangioma a. Pathophysiology: The cause of cherry hemangiomas is not well-recognized (Kim, Park, & Ahn, 2009). Cherry hemangiomas often increase in number as the individual
SKIN DISORDERS 7 ages; thus, the aging process affects the pathogenesis of the development of cherry hemangiomas (Kim et al., 2009). Cherry hemangiomas are shaped from an overgrowth of small veins (Visual DX, n.d.). Cherry hemangiomas can be associated with pregnancy, chemical exposure, climate, and having a liver transplant (Kim et al., 2009). b. Description: Cherry hemangiomas are a red-purple papule typically seen in older adults (VisualDX, n.d.). Sometimes cherry hemangiomas can become a dark brown to black papule (VisualDX, n.d.). They are frequently located on the torso or upper extremities; however, they can be found on the face, hands, and feet (Kim et al., 2009). The papules can range from one to five millimeters (Kim et al., 2009). If the papule is exposed to trauma, there is a risk for bleeding to occur (Kim et al., 2009). c. Explanation: Cherry hemangiomas appear to be asymptomatic (Kim et al., 2009). Therefore, when DH was unsure when the papules started, that could be a normal history finding. They present as multiple, bright, red-purple papules in individuals over the age of 30 years old (Ball, Dains, Flynn, Solomon, & Stewart, 2019; Kim et al., 2009). Cherry hemangioma is likely the diagnosis in this scenario due to the patient’s history of no trauma, and unknown when papules occurred. The lesions appear as multiple, bright, red-purple papules on the torso of DH, and his age is consistent with the literature. d. Guidelines: Cherry hemangiomas are asymptomatic; therefore, treatment is not necessary (Kim et al., 2009). Cherry hemangiomas can be removed for cosmetic reasons or to prevent bleeding if a trauma occurs (Kim et al., 2009). The provider, in
SKIN DISORDERS 8 this scenario, can educate the patient on what cherry hemangiomas are and that there is no treatment necessary.
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- Summer '15
- Trigraph, Dermal and subcutaneous growths, Pyogenic granuloma, hemangioma