Inflammatory Changes in Long-standing Post-traumatic Leg Cyst

Case at a Glance

A 31-year-old female presents with acute inflammatory changes adjacent to a chronic post-traumatic cyst on her lower extremity that has been present for 14 years following a motor vehicle accident.

Patient's Story

The patient sustained injuries in a motor vehicle accident in 2010, after which she developed a small, darkly pigmented subcutaneous nodule on her leg. The lesion remained stable for over a decade, appearing as a small black bump with only the tip visible through the skin, though the full size was palpable beneath the surface. She consulted multiple physicians over the years but received no definitive diagnosis. Recently, a physician identified the lesion as a benign cyst and discussed potential cosmetic removal, noting possible complications including debris accumulation and enlargement. The patient declined intervention at that time.

Initial Assessment

Physical examination revealed a chronic, stable subcutaneous cyst with recent development of an adjacent erythematous, tender nodule larger than the original lesion. The patient reported no systemic symptoms or previous inflammatory episodes.

The Diagnostic Journey

The patient's long-standing lesion had previously been evaluated by multiple practitioners without definitive diagnosis. Recent clinical assessment by a physician familiar with her case identified the lesion as a benign cyst, likely of traumatic origin given the clear temporal relationship to her accident.

Final Diagnosis

Inflamed epidermoid cyst, likely secondary to the original post-traumatic lesion, with adjacent inflammatory reaction.

Treatment Plan

Conservative management with close monitoring was recommended given the patient's overall health status and lack of systemic symptoms. The patient was advised to observe for signs of increased pain, fluctuance, or systemic symptoms that would warrant immediate medical attention for possible incision and drainage.

Outcome and Follow-up

The patient was counseled on home monitoring techniques and warning signs requiring urgent medical evaluation. Given financial constraints, a conservative approach was deemed appropriate with instructions to seek immediate care if the lesion became significantly more painful or showed signs of abscess formation.