It was “wait and see” until the bleeding began, and wouldn’t stop.
It’s a busy Sunday afternoon in the ED. The weather outside is gorgeous (or so you’re told—why don’t they put windows in Emergency Departments?). Anyway, you might have guessed it by the number of lacerations, fractures and general playground mishaps you’ve been seeing. So when the nurse walks by escorting a young man with a bandage on his jaw to the room down the hall, you logically assume it’s another laceration to repair and send the resident in to size things up.
Ok, you’re wrong. The resident comes to find you a short time later with that “help me figure this out” look they get from time to time. She tells you that she doesn’t know what this is but it won’t stop bleeding.
The patient is an eight-year-old male. He has a history of mild asthma but is otherwise healthy. About one month ago his mother noticed a red bump on his left jaw line. It has been increasing in size since then. It does not itch or pain him, in fact they had adopted a ‘wait and see’ approach since he had his annual physical coming up anyway. However, three days ago it started bleeding. Mom’s not sure what he did that started the bleeding, the patient thinks he might have scratched it. They put a Band-Aid on it which seemed to slow things down, but every time they removed the bandaid it was bloody, and today they have switched to gauze, which they are changing every hour or so because it keeps oozing.
The child has not had any fevers or systemic symptoms. He hasn’t had any other problems with bleeding or bruising. The family history is negative for anything but asthma and seasonal allergies. The child is taking no medications. His physical exam is completely unremarkable until you remove the bandage.
“What is that?” asks the resident. Underneath the gauze you find a red, soft, bumpy, growth on a small stalk. It is continuously oozing a small trickle of blood, which does not stop with pressure.
What is it? It’s a pyogenic granuloma. These are little capillary hemangiomas that can occur at the site of an injury. They are known to develop in the cysts of acne patients. Hormones can also stimulate their development—they can occur in the gingiva of pregnant patients where they are called epulis.
What is it? It’s a pyogenic granuloma. These are little capillary hemangiomas that can occur at the site of an injury. They are known to develop in the cysts of acne patients. Hormones can also stimulate their development—they can occur in the gingiva of pregnant patients where they are called epulis.
Pyogenic granulomas are typically less than 1 cm in size. They can be yellow to red in color and dome-shaped. They grow rapidly. Patients most likely to have these are children and young adults. They are most often seen in the head and neck region, as with this patient, or the extremities, particularly the fingers.
The problem with pyogenic granulomas is that they are fragile and bleed easily. The bleeding can be hard to stop, as with this patient. Treatment is curettage, sometimes with electrodessication. It is important to remove all the tissue—if anything is left it tends to recur. Left alone, they will usually resolve spontaneously in about 6 months.
Leaving this alone for 5 more months is not an option in this child—he’s already been bleeding for 3 days. Send him to school like this and the school nurse will be phoning the mother to come get him within the hour. Something needs to be done today.
You control the bleeding temporarily with epinephrine-soaked gauze. You then apply a silver nitrate stick for now. With the bleeding temporarily controlled you refer him to the Surgery clinic for definitive removal of the lesion.
He should do well. The mother will have to monitor him for recurrence. It’s probably a good idea for the surgeons to send the lesion for path after they remove it, just to prove it’s not a melanoma since it grew so fast, but the appearance and course are typical.
Amy Levine, MD is an assistant professor of pediatric EM at UNC Chapel Hill.
7 Comments
My 11 year old HFA son has one of these that appeared about 2 months ago. I mistakenly thought it was a blood blister and thought I would just scratch it off and it would heal. However it started to bleed and pressure would not stop exactly how you described in your article. So you are saying that if left alone it will go away in 6 months? If so that’s fine he doesn’t scratch it and it’s not bothering him one bit it is between his elbow and shoulder on his arm. Thank you for posting this article and thank you google for making easy to find.
My 13 month old son has this too. On his face/right cheek. First showed up a couple of months ago. Grew a little then popped. He bled for 2 hours while at urgent care. MD thought is was a laceration even put that in his visit notes. But we kept telling him it wasnt a cut it was a pimple looking thing. MD tried gluing it but too much blood. Silver nitrate finally did the trick. We are seeing his pediatrician asap. He had an umbilical granuloma as well. Getting worried granuloma is a common word here. I was on blood thinners/lovenox through out my pregnancy hope this isnt some how connected 🙁
I am a 52 year old male and have a similar cyst I believe on a very personal and private area that has been there for almost 8 years I have pierced it to drain it believing that it was a blood blister however it bled to the extent that I was considering going to the ER however because of its location I was very shy and not looking forward to having anyone else handling it. It did eventually stop bleeding and I got brave enough to try it a second time after about a year and it bled under very high pressure it did not just seep or lose it truly was I don’t want to say pulsing but under extreme pressure any ideas as to what it could be or how I could cure it without having to have somebody else involved and yes it does affect my love life not because of any pain I just need to make sure that the lights are all turned out before engaging In romantic opportunities any advice would be greatly appreciated
I’m 46 i got a tiny bump on my left eyebrow for about 2-3 year’s but it would never go away so i decided to pop it big mistake it keeps pumping out blood non stop.
My young adult daughter also had this problem. She’s had pimples before in her private area, and gently nicking them so they can drain then taking a soak in salt and vinegar bath usually helped, sometimes needing to apply a pad to absorb the drainage. But this time it bled for hours, and I had her try witchhazel which didnt stop it, so now have her trying a styptic pencil. Like what men use for a shaving nick, but I’ve used it for years to stop the bleeding after I cut off a skin tag. But with yours going on for 8 years, you need to see a doctor and see if you can have it fixed.
I have one and I’ve been looking for ways to get rid of it. How did you get rid of it?!
This same thing occured in my 19 yr old. It happened last night and the next morning at 4 am it’s still bleeding. We placed cotton and a bandaid o not to catch the blood. He doesn’t want to go to the Doctor at all. We may end up there .