Cystic Hygroma in a Boy of 5 Months

ABSTRACT : A baby boy 5 months old from Satara, Maharashtra came in NMRMHH Opd with complaints of swelling over the lower mandibular region since birth on 30/05/2018. Based on totality of symptoms, Calcarea iod 30 was prescribed and then in further follow ups, Scrophularia nodosa 200, Baryta iod 30, Calcarea carb 200, which proved to be effective in resolving the cystic hygroma, hence avoiding surgical intervention and widening the scope of homoeopathy.

KEYWORDS: Homoeopathy, Cystic hygroma, Calcarea iod, Scrophularia nodosa, Baryta iod, Calcarea carb

ABBREVIATIONS: NMRMHH – Nyaymurti Madhavrao Ranade Memorial Homoeopathic Hospital, CH – cystic hygroma, FTND – Full term normal delivery, H/o – history of, NAD – No abnormality detected

INTRODUCTION: Lympho-vascular malformations:  Also known as lymphangiomas. These are benign vascular lesions made of fluid filled spaces (cysts) thought to occur due to abnormal development of the lymphatic system. They are present at birth, although in some cases they can be discovered later. Types: Depending upon the size of the cyst- macrocytic 2. microcystic 3. combined. Depending upon the depth: Superficial lesions are known as lymphangioma circumscriptum. Deep seated lesions – Cystic hygroma (CH) and Cavernous lymphangioma.

A cystic hygroma (CH) is a fluid filled sac that results from blockage in the lymphatic system. It is most commonly located in the neck or head area, but can be located anywhere in the body.

Symptoms vary depending on its size and specific location, and it can potentially cause problems with nearby structures or organs. A CH may be caused by genetic or environmental factors that cause abnormal development of the lymphatic vascular system during embryonic growth.

It may occur on its own as part of genetic syndrome with other features of them, such as Turner’s syndrome or Down’s syndrome. Various Treatment modalities are available for removing the cystic hygroma surgically, sclerosing medicines, radiation therapy or sometimes chemotherapy.

This patient was referred to us by a student in an attempt to avoid surgery and its risks in a five month old child.

CASE HISTORY: Patient presented with swelling over the lower mandibular region more towards right side since birth and it has not increased in size since then.

Negative history: No history of fever, pain, difficulty in swallowing or breathing. No history of forceps delivery or any trauma to the face or head during delivery.

Past history: No specific history of any major illness. No specific history of intake of any medication or surgery.

Birth history: FTND

Birth weight- 3.1 kg

• Vaccinations – given till age.
• Milestones: head control+, bi-dextrous grasp+, sitting with support +.
• Family history: no H/o major illness
• Mother’s history during pregnancy: Pre eclampsia managed with allopathic intervention.
• Personal history:
• Appetite, Thirst – normal
• Bowels- Passes stool every 2 days, soft.
• Urine – adequate
• Perspiration – Profuse – on head, scalp; not offensive; no staining.
• Sleep – Normal – no specific fixed position or frequent change of position.
• Thermals- towards hot. (does not want covering while sleeping)
• General examination:
• Build- Chubby Child.
• Nourishment- Good
• Temperature – afebrile
• Pulse – 104/min
• Respiratory rate – 28/min
• Pallor, Icterus, Cyanosis, Clubbing absent.
• Systemic examination: NAD
• Local examination- a non-tender, soft swelling with well-defined borders along the right side of mandible. No warmth or redness.

Investigation done:

USG SOFT TISSUE SWELLING : On 16^th 2018

E/O approximately 4.0 x 2.7 x 1.8 cm cystic lesion with fine internal septations within is noted along the angle of mandible on right. Possibility of lymphovascular malformation should be considered. This lesion is closely associated with the right parotid gland. Further evaluation by MRI is suggested for exact anatomical delineation of the lesion.

FINAL DIAGNOSIS: Cystic hygroma

 CASE ANALYSIS:

Physical Generals:

• Profuse perspiration on scalp
• Thermally- hot

Physical particulars:

• Swelling over right mandibular region.
• Passes soft stools after 2 days.

Totality of symptoms:

• Profuse perspiration on scalp
• Thermally- Towards hot
• Swelling over right mandibular region.
• Passes stools after 2 days.

REPERTORISATION:

• REASONING BEHIND SELECTION OF REMEDY & POTENCY: Calcarea iod 30 Qid was given as the first prescription.  The various remedies given were selected on the basis of repertorisation or sectoral totality as there was a paucity of symptoms.

We referenced Boericke’s Materia medica, Dictionary of Materia Medica by Dr. J.H. Clarke and Lotus Materia Medica by Dr. Robin Murphy.

• Calcarea iod: Action on enlarged & indurated glands. Painful nodular tumors.
• Scrophularia nodosa is a powerful remedy whenever enlarged glands are present. Scrofulous swellings, nodosities.
• Baryta iod: Acts on the lymphatic system, Indurated glands, Tumors.
• As the case was completely pathological we have strived to achieve the result by giving successive multiple remedies.

FOLLOW UP:

CONCLUSION: In this case, understanding the pathology as purely surgical, the scope of homoeopathy is very sparse but our attempt with the help of multiple successive remedies as and when indicated by the totality of symptoms shows us the effectiveness and increases our horizon for attempting to give homeopathy in surgical cases.

REFERENCES:

1. Bailey & Love’s. SHORT PRACTICE of SURGERY. 26^th New York: CRC press; 2013. p. 701
2. Boericke W. Boericke’s New Manual of Homeopathic MATERIA MEDICA with REPERTORY. 3^rd New Delhi: B Jain Publishers (P) Ltd; 2014. p. 98-99, 135, 510
3. RADAR 10. Archibel Homoeopathic Software. Belgium: 2009
4. Clarke J. A Dictionary of Practical Materia Medica. New Delhi: INDIAN BOOKS & PERIODICAL PUBLISHERS; 2006. p. 253, 356, 1127-1130
5. Murphy R. LOTUS MATERIA MEDICA. 3^rd Noida: B. Jain Publishers (P) Ltd; 2010. p. 313, 408, 420, 1745-1747