Mirza Khizar Hameed.
Klippel - Trenaunay syndrome, as a rare cause of epistaxis.
Pak Armed Forces Med J Jan ;54(1):129-31.

A 10 years old girl was brought with complaint of slight but persistent bleeding from the right side of nose. On examination, anterior rhinoscopy showed a minute bleeding haemangioma on right Little`s area of the nasal septum over a raised purplish nodule. The nasal cavity was packed with ribbon gauze soaked in 4% lignocaine for ten minutes and then the bleeding point was cauterized electrically. The child was advised local application of Polyfax ointment and painkiller. Her vital signs were stable and she was investigated, all labs which were within normal limits. Further examination of the child showed soft tissue hypertrophy of right cheek with a port wine stain on it. She also had a hemangioma on the tip of the tongue and another sublingually on the right side extending to the floor of mouth. This child also had soft tissue hypertrophy of the right hand with increase in girth by 0.9 cm as compared to the left hand, while there was a port wine stain on the dorsum of the left hand. Both the hands showed clinodactyly. There was no evidence of entrapment syndrome. Her right foot was also hypertrophied and had resulted in a slight limp. Clinically it appeared to be soft tissue hypertrophy resulting in increased in girth by 1.5 cm as compared to the left foot. According to her mother, all these abnormalities were present since birth except intra oral lesions, which she had not noticed. These anatomical anomalies had become prominent as the child grew. There was no history of seizures and mental retardation.

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