FEBRUARY 22, 2023
THIS IS AN ONLINE E LOG BOOK TO DISCUSS OUR PATIENT'S DE-IDENTIFIED HEALTH DATA SHARED AFTER TAKING HIS SIGNED INFORMED CONSENT. HERE WE DISCUSS OUR PATIENT'S PROBLEMS THROUGH SERIES OF INPUTS FROM GLOBAL ONLINE COMMUNITY EXPERTS WITH AN AIM TO SOLVE THOSE PATIENT'S CLINICAL PROBLEMS WITH COLLECTIVE CURRENT BEST EVIDENCE BASED INPUTS.
53 YR OLD MALE PRESENTED TO THE OPD WITH C/O SWELLING OF BACK OF NECK 7 YRS AND RIGHT THIGH SINCE 5 YRS.
HOPI : Patient was apparently asymptomatic 7 yrs back then he developed swelling in back of neck which was insidious in onset gradually progressed to progressed to present size.
5 years back he had H/o trauma + (?wooden stick injury)
6 months later he noticed the swelling Initially started on the right side and progressed to involve first the lateral part for 2 years then progressed to medial part of the thigh also
On prolonged activity there is a little bit increase in size of the swelling with tightening of overlying skin
No pain or restriction of movements
PAST ILLNESS
N/K/C/O Epilepsy HTN DM CAD CVA TB Asthma
Personal history:
Normal appetite takes veg diet (non-veg stopped 2 years ago). He is a garment shop owner, regular bowel habits, normal micturition, no allergies and addictions.
Family History:
Father has hypertension
GENERAL PHYSICAL EXAMINATION
Patient conscious coherent cooperative
Moderately built and nourished
No, icterus, cyanosis, clubbing, pallor, edema, lymphadenopathy
Vitals:
Bp:130/90mmhg
RR-16cpm
PR-98 bpm
TEMP-98.1F
Cardiovascular System: S1, S2 heard, no murmurs
Respiratory System: Bilateral air entry present. Normal vesicular breath sounds heard. Position of trachea central.
Central Nervous System: patient is conscious coherent and cooperative. Higher mental functions intact
Per abdomen: soft, non-tender, no guarding and rigidity
L/A:
INSPECTION:
A single swelling over Right Thigh region of size 20*15 cm and of elliptical shape. No discharge from the swelling, no visible pulsations dilated veins scars sinuses seen.
No redness, skin over the swelling is shiny.
PALPATION:
No local rise of temperature or tenderness.
All inspectory finding are confirmed
A single swelling over Right Thigh region of size 20*15 cm and of elliptical shape and cystic in consistency.Surronding skin is normal. All borders are well defined and swelling non mobile in all directions. Skin over the swelling is pinchable.
INSPECTION:
A single swelling over back of neck region of size 4x4 cm and of oval shape. No discharge from the swelling, no visible pulsations dilated veins scars sinuses seen.
No redness, skin over the swelling is Normal.
PALPATION:
No local rise of temperature or tenderness.
All inspectory findings are confirmed
A single swelling over back of neck region of size 4x 4 cm and of ovoid shape and soft in consistency. Surronding skin is normal. All borders are well defined and swelling non mobile in all directions. Skin over the swelling is pinchable.
Provisional Diagnosis:
Lipoma over the nape of neck
Swelling over Rt thigh? Lipoma
of the Right Thigh
INVESTIGATIONS:
TRUE CUT BIOPSY:
MRI: 
Xray
26/04/2023
[15-07-2025 20:52] PPM 1: Ae bhabe duto pa eksathe share korun jemon aager uporer chobi te dekhano hoyeche
REPORTS:
USG
Orthopaedics referral was done i/v/o any bony involvement and xray was advised which was normal
General Surgery opinion was taken i/v/o liposarcoma and true cut biopsy was adviced and done on 22/2/23
the patient was asked to report to General Surgery OPD with biopsy reports
Management:
Tab.Dolo 650 mg sos
Tab.MVT po/od
Tab Vit C po/od
T.MVT po/od x 15 days @2pm
Report to General Medicine OPD and General Surgery OPD with biopsy reports after 1 week
26-04-2023
Patient came for follow up and for biopsy. Oncosurgeon advise was taken. USG guided multiple trucut biopsies targeting specific areas to be recommended. Incision biopsy in soft tissue tumour is not advisable, to avoid gross tumor spill into intramuscular planes and subcutaneous tissue which would compromise limb conserving compartmental resection later.
27/04/2023
S:
O:
Patient is conscious, coherent, cooperative
Temp:98.6°F
BP:120/90mmhg.
PR:68bpm.
RR:18cpm.
CVS: S1, S2 HEARD, NO MURMURS.
RS: BAE+, NVBS.
Abdomen: soft, non-tender
CNS: NFND
A:
Swelling of right thigh? Lipoma? Liposarscoma
P:
Tab MVT PO / OD
Vitals monitoring 6 th hourly
[15-07-2025 20:04] PPM 1: Apnar patient last jokhon admit hoye ekhane biopsy koriyechilen shei report ta apnar kache ache?
[15-07-2025 20:16] PA: J pata amar biopsy hoya se, Seta danpa amar pboltaroblam ,Bapa.
Ame dan ba bol te bhula gachi. 🙏🙏🙏
[15-07-2025 20:23] PA: Ame bolta bhula gachi dan pa biopsy hoya se dan pa bhalo acha.
Problam dan pa. 🙏🙏🙏
[15-07-2025 20:28] PPM 1: Duto payer bortoman chobi pathan jaate patient er mukh na dekha jai.
Aekhane jei payer chobi guno dekha jacche 👇
bortomane koto ta poriborton hoyeche sheta jana dorkar
[15-07-2025 20:35] PA: Ame bhula gachi jeta biopsy koriyechi seta dan pa dan pa tik acha.
Problam bapa 🙏🙏🙏
[15-07-2025 20:36] PPM 1: 👆
[15-07-2025 20:38] PA: Ok, Bapa
[15-07-2025 20:53] PPM 1: Bam paye kone jaigai byatha ekta pointer diye dekhan
[15-07-2025 22:20] PPM 1: Thanks
Please show the exact site of pain with a pointer
[15-07-2025 22:25] PA: Bapa jora kora mele bosle vition bTha hoy komor theka hil of the.
[16-07-2025 06:36] PPM 1: Komorer pechone? Haanthar somoi o ki byatha hoi kimba baare?
Byatha kichu ekta korle bere jai kimba kichu karone komeo jai?
[16-07-2025 06:37] PPM 1: Byatha ta shuru hole kotokkhon thake?
Gotokal ghontai ghontai deener kone somoi tai byatha ta lokkho korechilen?
[16-07-2025 14:15] PA: Gotokal sondhar por theka
Jokhan pa bhaj kora boshe thaki tokhan ajte jata komor ar joen theka batha sur hoy joto somoy bashe hocche bosa sathe sathe
Batha prochonddoh hocche
Hil of the tokhan drate gale komor soja korta pari na rog mone hoy choto hoya
Gache darate gale jilik
Marche mone hoy elektrik sok dicce ajte jate komor soja korta khubi।kosto hoy ak bar darate parle batha koma jay
[16-07-2025 14:15] PA: 🙏🙏🙏
[16-07-2025 16:19] PPM 1: Shune prolapsed intervertebral disc mone hocche
Okhane local daktar ke dekhiyechilen?
[16-07-2025 18:09] PA: Ha homeopathy daktar dakheyache daktar sorsar danar moto 7 diner tablet deya bolan aktu somay lak be sere jaba.
15 din holo khacci kechu bojha jacce na kekorbo.
🙏🙏🙏
[16-07-2025 18:13] PA: Une akjon medikal ofichar
Homeopathy
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