The Medics Abroad summer electives are currently underway in Malindi, Kenya. Our medical students have been there for just under a week and have seen a whole lot of medical conditions that they have only ever encountered in textbooks. The opportunities for hands-on clinical experience have been endless. From scrubbing in for a hemicolectomy in a rare case of intussusception in an elderly female to stitching up lacerations in the Emergency department. It has been nothing short of fulfilling for them.
Here’s a case one of our medical students (Manar Alyusuf) from the Royal College of Surgeons in Bahrain encountered 2 days ago.
A 2-day old newborn male was admitted to the Newborn Intensive Care Unit with a congenital mass on the left clavicular region along the sternocleidomastoid muscle. The 16-year-old mother had a prolonged 2nd stage of labor which delayed the spontaneous vaginal delivery, resulting in severe birth asphyxia. The baby was immediately resuscitated and showed no signs of meconium exposure.
On examination at the time of birth, the vital signs of the baby were:
- Pulse rate= 128 bpm
- Respiratory rate= 60 breaths/min
- Temperature = 35 degrees Celsius.
The head circumference was 35 cm with normotensive fontanelles, there were no signs of jaundice, cyanosis or conjunctival pallor. In addition to the mass on the neck, a second smaller mass was found on the scapula on the superior part of the left trapezius muscle. On inspection of the chest, there were no obvious deformities and the chest wall was moving symmetrically during respiration. On auscultation of the lungs, there was bilateral air entry and no added sounds were heard. With regards to the heart, both heart sounds 1 and 2 were audible, there were no murmurs, no thrills and the apex beat was in the 4th inter-coastal space mid-clavicular line which is normal in neonates. The abdomen was soft, tender with no masses or distention.
In the newborn intensive care unit, the baby was taken for an ultrasound which revealed the left lateral mass to be a cystic lesion with echoes and septations. Moreover, no organs or any nearby structures were compromised.
Physical examination on the second day showed that the Temperature was 37.2 degrees celsius, Pulse rate= 104 bpm and Respiratory rate= 30 breaths/min. The fontanelles remained normotensive, on palpation of the mass, it was soft, tender and caused no pain or distress to the baby. The chest examination didn’t show any abnormalities.
The baby is currently under surgical review, where the mass is being observed on a daily basis for any changes. Then a decision will be taken on whether to surgically excise the mass or aspirate it within the next couple of days.
Manar Al Yusuf is a medical student at Royal College of Surgeons Ireland, in Bahrain.