A 4-year-old female with ...

A 4-year-old female child R/O Morbi, Gujarat, presented to Civil Hospital Ahmedabad with swelling in the left upper limb since birth. At the time of birth, her parents noticed that her left upper limb was slightly bigger in size compared to her right upper limb, and this gradually progressed to its present size. She was delivered by normal spontaneous vaginal delivery at 39 weeks gestation without any complications. The mother's pregnancy progressed smoothly, with no complications or notable environmental exposures. There was no family or parental history of inherited vascular disorders, and the parents were not blood relatives. The child had no history of fever, pain, insect bites, or trauma. Additionally, she did not suffer from DM, HTN, congenital heart disease, and TB. Her appetite was adequate, and bladder and bowel movements were normal. Heart sounds were normal, with no murmurs, and there were no respiratory or intra-abdominal abnormalities. The neurological examination revealed no abnormalities. On examination, diffuse/generalized swelling of the left upper limb was observed, involving the arm, forearm, hands, and fingers. There was no erythema, ulceration, discharge, or tenderness. These features were consistent with a diagnosis of Klippel-Trénaunay syndrome. A full blood count reported anemia (Hb-10.9, RBC-5.6*10^6/mm). A color Doppler ultrasound examination of the left upper limb was performed, which demonstrated hypertrophy of the skin and subcutaneous tissue, along with multiple small vascular channels showing slow arterial and venous flow. The findings were suggestive of a congenital overgrowth syndrome with slow-flow vascular malformation, specifically Klippel-Trénaunay syndrome. Lymphoscintigraphy was ordered for further evaluation of lymphedema. The patient was managed conservatively with antibiotics such as Amoxicillin+Clavulanic acid 500 mg (TDS) and analgesics like Ibuprofen 200 mg (BD). Physiotherapy treatment included exercises, elastic compression bandages, manual drainage, an arm pump, and keeping the arm raised etc.