Venous aneurysms are rare entities usually found at physical examination or imaging exams. Their rarity justifies the need for investigation and publication of case reports, the objective of the present report. We report the case of a 30-year old female with history of an asymptomatic enlarging mass in the neck for 10 years. She underwent resection of the mass and left external jugular vein ligation under general anaesthesia. A literature review shows that venous aneurysms can cause thrombophlebitis and pulmonary embolism or undergo spontaneous rupture which can further complicate the situation for both anaesthetist and surgeon. Prophylactic surgical treatment is recommended for low-risk patients with venous aneurysms of the abdomen and strongly recommended for most patients with lower extremity deep venous aneurysms. Other venous aneurysms should be excised only if they are symptomatic, enlarging or disfiguring.
Pain is a common and highly distressing symptom in children with advanced malignancies and it is often multifactorial at the end-of-life. The prognosis of cancer pain is reported to be worse in those with mixed pain type, high pain severity, daily opioid use, and poor emotional well-being. We describe a case of 13-year-old boy, known case of metastatic Ewing sarcoma right iliac bone, who presented to our palliative care ward with intractable pain and was finally discharged home for terminal care with high doses of morphine, ketamine, and midazolam infusion through elastomeric pump attached to a peripherally inserted central catheter (PICC line). The suffering of imminently dying children should be reduced, and judicious dose escalation of opioids along with adjuvants is appropriate and often necessary.
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