December 2013






History: This one day old infant was born at 36 4/7 weeks gestational age to a G1P0 in a rural community hospital. The pregnancy was complicated by pre-eclampsia and the patient was born via uncomplicated vaginal delivery. She was initially brought to the newborn nursery; however, several hours after birth she was noted to have decreased capillary refill and mottling of the right lower extremity that did not resolve with warming. She remained asymptomatic, but transfer was initiated to a children’s hospital for concern for vascular malformation.

Past Medical History: None 

Allergies: No known drug allergies

Family History: maternal cousin died in infancy of congenital heart defect

Medications: none

Physical Exam: erythematous to violaceous reticulated patches overlying right lower extremity extending from hip to foot (Fig. 1, Fig. 2, Fig. 3)

Laboratory data: Normal CBC and CMP

Imaging studies: Venous and arterial Doppler of right lower extremity within normal limits, echocardiogram within normal limits



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