CASE 1-Surgery Excision Lipoma.pptx

Lipoma case presentation

1. WIDE EXCISION OF UPPER BACK SOFT TISSUE TUMOR WITH DIRECT FLAP CLOSURE ARANILLA, HANAKO S.

2. General data Name: L.L. Sex: M Age: 60 y/o Birthdate: March 12, 1962 Address: Tanauan City, Batangas Status: Married

3. History 13 September 2022 CC: Back mass HPI: >10 years – lesion started as a <1cm in diameter nodule in the R scapula (-) consult done 2021 – noticed growth of a second nodule above the first (-) consult done  lesions slowly increased in size up to present 2 weeks PT Operation- consult was done. Advised excision of back mass. (-) trauma to site of mass prior to onset (-) pain on mass (-) erythema (-) discharge (-) open wound (-) recent weight loss (-) fever

4. HISTORY Past Medical and Surgical History: >20 years ago- Cholecystectomy Denies DM, HTN, Cancer, TB, Asthma, CVD No Maintenance medications

5. HISTORY Family History: DM: sibling HTN: mother CVD: mother side Cyst on neck: father Back mass: brother Personal & Social History: non-smoker, occasional alcoholic drinker Supervisor- sugar cane plantation

6. HISTORY ROS: (-) fever sig. wt. loss (-) headache (-) DOB / cough (-) hemoptysis (-) jaundice (-) edema (-) bone pain (-) bleeding s/ sx (-) polyuria / nocturia (-) polyphagia / polydipsia (-) non-healing wound (+) left back pain occasional

7. PHYSICAL EXAM General: alert, awake, conscious, coherent VS: BP = 130/90 mmHg PR = 78 bpm RR = 18 cpm O2 sat = 99% T = 35.8 C

8. PHYSICAL EXAM HEENT: pink palpebral conjunctiva, PERRLA, EOM intact C/L: SCE, (-) retractions, (-) adventitious breath sounds Back: 4cm diameter soft mobile mass underneath the skin, smaller 2cm soft mobile mass above the bigger mass Heart: NRRR, (-) murmur Abdomen: flat, normoactive bowel sounds, soft, non-tender Back Left Right

9. PHYSICAL EXAM Extremities: (-) pallor (-) edema, CRT <3s, warm, full equal pulses Neuro : GCS = 15 CN’s= intact Motor- 5/5 all extremities Sensory- 100% all extremities

10. Upper back soft tissue tumor ASSESSMENT

11. DIFFERENTIALS RULE IN RULE OUT Lipoma Soft, mobile non painful mass Non erythematous Not warm No punctate (eye) Slow growing Epidermoid Cyst Soft mass -no punctate opening Liposarcoma Mass -sarcomas usually firm, non-mobile -usually aggressive in growth -absence of other constitutional symptoms

12. LIPOMA common benign tumors of mature fat which may be subcutaneous, extra muscular, or intramuscular. Symptoms usually a painless mass that has been present for a long time exception is the angiolipoma, which is painful when palpated Physical exam palpable, mobile, painless lesion

13. LIPOMA Demographics slightly more common in men affects predominantly patients between 40-60 years old develops in sedentary individuals Anatomic location superficial/subcutaneous location is common superficial lesions are common in the upper back , thighs, buttocks, shoulders and arms deep lesions are affixed to surrounding muscle, in the thighs, shoulders and arms ~5-10% of patients with a known superficial lipoma, will have multiple lesions

14. LIPOMA Types: Common variants of lipoma include spindle cell lipoma       pleomorphic lipoma angiolipoma intramuscular lipoma hibernoma   Imaging: Radiographs CT Scan MRI

15. LIPOMA TREATMENT PLAN Nonoperative observation only Operative resection  

16. INTRAOPERATIVE assessment Attending Physician : Dr. Quinto Pre-operative Diagnosis: Upper back soft tissue tumor Post-operative Diagnosis: Right upper back lipoma Procedure: Wide excision of upper back soft tissue tumor with direct flap closure Surgeon: Dr. Quinto Findings: 4 cm diameter soft tissue tumor adherent to adjacent structures, right upper back Type of anesthesia: local anesthesia Estimated blood loss: neglible Drain: Penrose drain #1

17. INTRAOPERATIVE assessment Specimen collected: Upper back soft tissue tumor 4cm diameter Complications: None Post-Op Condition Patient tolerated procedure well VS stable Discharged with home medications- Celecoxib 200mg BID and Co-amoxiclav 650mg BIDx7 days Follow up on Sept. 20, 2022

18. RIGHT UPPER BACK LIPOMA POST-OPERATIVE FINAL DIAGNOSIS