P-wave Centric Ambulatory ECG Monitoring in Infants and Young Children

BackgroundP-wave centric ambulatory ECG monitoring has emerged as an important tool aiding the diagnosis of arrhythmias. However, with no specific pediatric approved ambulatory monitors, efficacy and user experience with these devices in young infants have not been established.ObjectiveTo evaluate tracings quality in children less than 10 kilograms who have been prescribed the P-wave centric Carnation Ambulatory Monitor (CAM) patch by Bardy Diagnostics Inc.MethodsWe performed an observational, retrospective study on patients prescribed 48-hour ambulatory Holter monitoring. We aimed to detail our experience with using the CAM patch with a patient population smaller than the recommended weight set forth by Bardy Diagnostics Inc. All patients less than 10 kg who were prescribed a 48-hour CAM patch were included in this review. Additionally, 2 different monitor locations (over the sternum and horizontal over the left axilla) were assessed to address the optimal placement in small children less than 10 kg.ResultsA total of 33 CAM reports from 25 patients, aged 0-15 months were included in the study. Mean patient age was 4.2 months ± 5.0 and mean weight was 5.3 kg ± 2.4. Twenty-Four percent of patients (8/33) had known congenital heart disease. Indications for monitoring included: tachyarrhythmia (15/33, 45%), bradycardia (6/33, 18%), ectopic rhythm (9/33, 27%), cardiac tumor (1/33, 1%), and prolonged QT interval (1/33, 1%). All CAM reports showed clear, identifiable P waves which were diagnostic and lead to changes in medical management for 30% of patients (i.e. medication adjustments or discharge from cardiology care). When comparing the P wave between a 12-lead ECG and the CAM patch, 77% of patients had the same or similar P wave morphology to lead aVF.We found the recommended, upright placement over the sternum performed better than the horizontal placement over the left axilla for small infants and children less than 10 kg.ConclusionA P-wave centric Holter monitor is helpful in providing accurate diagnostics tracings even in infants and small children aiding in their clinical management.

Desmoplastic Fibroblastoma Invading the Humerus

Desmoplastic fibroblastoma (DFB) is an uncommon, benign, soft tissue tumor. The tumor most often presents as a slowly growing, painless soft tissue mass and is usually small. There have been only a few reports of patients with DFB who presented with bone invasion. Herein, we report the case of a 66-year-old woman with DFB with bone invasion in her left axilla. A lump under the left axilla was detected and was associated with pain and limited range of motion (ROM) of the shoulder. Computed tomography showed a soft tissue mass with invasion of the adjacent left humerus. Magnetic resonance imaging revealed a lesion with low signal intensity on T1- and T2-weighted images, and weak internal enhancement on postcontrast T1-weighted images with fat suppression. Histologic evaluation of a preoperative needle biopsy revealed DFB with FOSL1 expression. The tumor was marginally excised. Postoperative outpatient follow-up demonstrated a significant improvement in pain and ROM of the shoulder and no recurrence after 1 year. Even though DFB with bone invasion can cause pronounced clinical symptoms with pain and limited ROM, we conclude that simple excision is an adequate treatment.

Schwannoma of the long thoracic nerve in the left axilla: a case report

Schwannoma, which is also known as neurilemmoma, is a type of tumor that arises from the peripheral nerve sheaths. Cases of schwannomas located in different regions have been reported. Some schwannomas present as asymptomatic masses, while others cause discomfort, such as pain and numbness. Magnetic resonance imaging (MRI) is a valuable diagnostic tool. A 23-year-old woman presented to our hospital with a mass in the left axilla that was misdiagnosed as mammae erraticae. The patient also considered the condition to be mammae erraticae for approximately 14 months because of a lack of symptoms. MRI was recommended by a surgeon from the galactophore department. A giant schwannoma was found. The mass was surgically excised, while preserving the continuity of the long thoracic nerve. Routine histopathological analysis confirmed the presence of a benign schwannoma. Schwannomas located in the axilla are rare and may be easily misdiagnosed as mammae erraticae or enlarged lymph nodes. Early investigation is necessary to make the diagnosis, and surgical excision is usually curative.

Ectopic breast carcinoma presenting as sebaceous cyst left axilla

A 43-year-old woman with a positive family history of breast cancer presented with a painless lump in her left axilla for 2 years. Clinical diagnosis was a left axillary sebaceous cyst as the lump was inseparable from the skin. The lesion was excised under local anaesthesia and reported as breast tissue widely infiltrated by an invasive ductal carcinoma (grade 2). The malignancy was not involving the epidermis but <1 mm away from deeper margins. Re-excision of the deeper tissue with an axillary sentinel lymph nodes biopsy was performed and deep margins were reported to be tumour-free with no nodal involvement.