Concern About New Mark on My Daughter's Nose
I am a 33-year-old mother and recently observed an unusual mark on my three-year-old daughter’s nose. This change was first noticed three days ago, and I initially suspected it to be a stain from a marker because of its flat appearance. However, despite attempts to clean it, the mark remains and does not resemble a typical bruise or scrape. There’s no scab present, and as far as I can tell, there are no bumps; though, I recognize that at her age, she may have had a minor fall that went unnoticed. Currently, we are away traveling in an area where access to reliable medical care is limited. Generally, I am not overly anxious about health issues, but the sudden appearance of this mark—especially since I have checked older photos and confirmed it wasn’t there prior—has caused me some concern, particularly given our distance from our regular healthcare providers. I am left wondering if this issue warrants a visit to a pediatrician or dermatologist soon. Does anyone have insights on what this could be and whether it necessitates immediate attention?
Answers (1)
7/10/2025, 3:30:54 AM
OpenHealth AI
It's understandable to feel concerned about any new mark on your child's skin, especially when it appears suddenly. The mark on your daughter's nose that has been there for three days and isn't responding to cleaning may have several potential causes, including something as simple as a pigmentation change, a minor injury that could have been unnoticed, or even a harmless skin condition like a hemangioma or a flat mole.
Here's a structured approach for addressing this situation:
Explanation:
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Possible Causes:
- Pigmentation Changes: Sometimes, areas of skin can change color without injury, which may be benign.
- Injury: A tiny fall could result in a bruise that looks flat and may not be apparent at first.
- Dermatological Conditions: Various harmless skin conditions can cause localized changes.
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Monitor Symptoms: Since there are no signs of infection (such as redness, swelling, warmth, or discharge), and your daughter otherwise appears well, the situation may be less urgent. However, it's crucial to keep an eye on the mark.
Next Steps:
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Document the Mark: Take a clear photo of the mark today so you can compare it over the next few days. Note any changes in size, color, or texture.
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Monitor for Symptoms: Keep an eye on her overall health. If she develops any additional marks, injuries, or symptoms such as fever or discomfort, these would be important to note.
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Gentle Cleaning: Continue to clean the area gently with mild soap and water. Avoid using any harsh chemicals.
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Plan for Follow-Up: Once you return home or have access to medical care, consider scheduling an appointment with either a pediatrician or dermatologist to evaluate the mark, especially if it does not improve or if you notice any changes.
In the meantime, try to stay calm and focus on monitoring her overall health. Many skin changes in young children are common and benign, but it's always good to stay informed and ready for follow-up if needed. If you notice any sudden changes in her health, seek medical attention as soon as possible.
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# 7-Month-Old Child with Abernethy Malformation - Exploring Treatment Options ## [7-Month-Old] Identified with Abernethy Malformation (Congenital Portosystemic Shunt) - Treatment Methods? **Age:** 7 months **Gender:** Female **Height:** Age-appropriate **Weight:** Currently 9 kg, was 2.8 kg at birth **Ethnicity:** Asian **Duration of Symptoms:** Present since birth **Location:** Uzbekistan **Pre-existing Health Issues:** Abernethy malformation (congenital portosystemic shunt), liver hemangiomas, chronic jaundice, anemia **Current Treatments:** Supportive management --- ## INITIAL PRESENTATION (June 2025 - July 2025) Our daughter arrived on **June 27, 2025**, presenting with: - Birth weight: **2.8 kg** - Marked jaundice (yellowing of skin and sclera) - Pale or clay-colored stools - **Bilirubin level: 245 μmol/L** (typically <20) An immediate ultrasound indicated multiple liver anomalies, initially thought to be hemangiomas. --- ## FIRST COMPREHENSIVE ASSESSMENT (August 1, 2025 - 1 Month Old) ### Multislice Computed Tomography (MSCT) with 3-Phase Contrast (August 1, 2025): **RESULTS:** - **Portocaval shunt size: 9.9 mm** (blood bypassing the liver into the inferior vena cava) - **Arteriovenous shunt size: 4.4 mm** - **Portal vein size: 6.1 mm** (patent) - **Three nodular cystic lesions** located in the perivascular area, with largest measuring 11.6×20.7 mm, enhancing during the venous phase - Liver features a heterogeneous architecture, exhibiting irregular enhancement - Gallbladder appears elongated and slightly enlarged - Other abdominal organs exhibit normal findings **RADIOLOGIST’S ASSESSMENT:** "Congenital portosystemic shunt indicative of Abernethy malformation; less likely arteriovenous malformation (AVM); cannot dismiss the possibility of localized liver lesions." **ADVICE:** Seek consultations with an abdominal and vascular surgeon. ### Blood Tests (August 1, 2025): **Complete Blood Count:** - WBC: 10.44 × 10⁹/L (normal range) - **RBC: 2.1 × 10¹²/L** (LOW - indicating severe anemia) - **Hemoglobin: 69 g/L** (CRITICALLY LOW; normal is 117-166) - Platelets: 403 × 10⁹/L (elevated) **Biochemistry Analysis:** - 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7 Months Old) - **Weight:** 9 kg (good growth rate in spite of condition) - **Jaundice:** Continues to be present (yellow skin) - **Stools:** Remain pale/clay-colored - **Development:** Achieving appropriate milestones - **Energy:** Appears to have a good energy level - **Feeding:** Normal appetite --- ## QUESTIONS FOR r/AskDocs We have been informed this is **Type 2 Abernethy malformation** (portal vein present). **Three treatment avenues have been proposed:** ### Option 1: **Endovascular Coil Embolization** (minimally invasive approach) - A catheter is inserted via the leg vein to access the shunt and deploy coils/plugs to close the abnormal vessels - Pros: No surgical incision, minimal discomfort, short hospital stay (2-4 days), no scars, enhanced safety - Duration: 1-2 hours - Recovery: 2-4 weeks for jaundice to show improvement ### Option 2: **Open Surgical Intervention** - An incision in the abdomen to ligate abnormal vessels and redirect blood to the liver - Pros: Direct visualization, effective results - Cons: Surgical scar, longer recovery time (7-14 days in hospital) - Duration: 2-4 hours ### Option 3: **Liver Transplantation** - We have been advised this is not necessary as the portal vein is functional and liver health is improving. --- ## SPECIFIC QUESTIONS TO CONSIDER: 1. **With a functional portal vein (6.1 mm) and improving liver function (ALT normalized), is it advisable to pursue endovascular closure as the preferred treatment?** 2. **Despite ALT levels improving, the bilirubin remains consistently high (242). Should this be a cause for concern? Is there a prospect for it to normalize post shunt closure?** 3. **Are the hemangiomas/nodules (11.6×20.7 mm) linked to the shunt? Will they likely resolve following shunt repair?** 4. **How urgent is the proposed intervention? Is immediate action required, or is there flexibility to wait a few months?** 5. **What complications should we be vigilant for during the waiting period?** 6. **Regarding endovascular closure - what is the average success rate for infants aged 7 months? Are there concerns regarding the shunt size (9.9 mm)?** 7. **The measurement of the portal vein has shown improvement from 6.1 mm to 3.9 mm; should this be perceived as a positive sign or a reason for concern?** 8. **Are there special directives (diet modifications, medications) we should consider while awaiting the procedure?** 9. **Post-procedure, how long should we expect it might take for:** - Normalization of bilirubin levels? - Return of stool color to normal? - Resolution of jaundice? - Regression of hemangiomas? 10. **Can you recommend any specialized centers for pediatric Abernethy malformation treatments? We are located in Uzbekistan but are prepared to travel (to Turkey, Russia, South Korea, etc.)** --- ## ADDITIONAL INFORMATION - No family history of hepatic diseases - Pregnancy and delivery were normal - No additional congenital defects identified - Immunizations up to date - No history of bleeding disorders - No signs indicative of encephalopathy - Child is alert and engaged --- **I can supply actual MSCT images and comprehensive lab reports if they would be of assistance.** We sincerely appreciate any insights you can provide. We are striving to make the most informed decision regarding our daughter’s care and highly value expert medical opinions. **TL;DR:** 7-month-old diagnosed with Abernethy Type 2 malformation (9.9 mm portocaval shunt, patent portal vein). Liver functionality is improving (normalized ALT) while bilirubin remains elevated (242). Evaluating options between endovascular coil embolization and open surgery. Seeking expert advice on optimal treatment strategy and timing.