A patient was seen as an emergency 2 weeks ago complaining of discomfort from a swelling left soft palate of a few months duration ( he is also a gagger)
Clinically some minor left cervical lymphadenopathy.
CT & MRI – non contributory
Differential diagnosis & possible management taking into account:
1) Covid 19 current state
2) Gag reflex – aerosol risk
My initial assessment had a Malignancy high on the list .
I got a second opinion from the oral pathologist who referred the patient- his opinion was :
1) Haemangioma
2) Kaposi sarcoma
Or………..
3) Pyogenic Granuloma
I then remembered a similar case many years ago which turned out to be a pyogenic granuloma
After MRI & CT assessment ( no significant lymphadenopathy) & considering the referring Oral Pathologist’s advice on performing an EXCISIONAL BIOPSY , under LA & gag reflex management with oral
1) Medazolam 15 mg
2) Metoclopramide 10 mg
the lesion was removed & sent for histology:
BIOPSY REPORT/ DIAGNOSIS:
PYOGENIC GRANULOMA
