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Blue Rubber Bleb Nevus Syndrome Workup

  • Author: Basil S Cherpelis, MD; Chief Editor: Dirk M Elston, MD  more...
 
Updated: Jul 14, 2016
 

Laboratory Studies

The following laboratory studies might be warranted:

  • Fecal occult blood test: Screen for occult blood loss from GI blue rubber bleb nevus syndrome (BRBNS) lesions.
  • CBC count: Screen for iron deficiency anemia.
  • Urinalysis: Hematuria may be caused by lesions in the bladder.
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Imaging Studies

Radiographic imaging of suspected bone and joint involvement can be useful in identifying fractures, bony overgrowth, and articular abnormalities. Radiographic images in blue rubber bleb nevus syndrome (BRBNS) may be useful in suspected bone or joint involvement to detect fractures, bony overgrowth, and articular derangement. Radiographic contrast techniques may detect GI lesions, but endoscopy is considered to be superior.

MRI has been described as a useful tool for detecting extracutaneous lesions and for screening asymptomatic family members.

Technetium Tc-99m–labeled red blood cell imaging may be helpful to localize or delineate the extent of bleeding in patients with blue rubber bleb nevus syndrome.[23]

CT scans can be useful to assess for underlying complications such as volvulus, intussusception, infarction, and GI bleeding.[2]

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Procedures

Endoscopy may be warranted in blue rubber bleb nevus syndrome (BRBNS). GI lesions may be demonstrated by endoscopic examination or by radiographic contrast techniques. Upper GI endoscopy is more sensitive than an upper GI series and colonoscopy more useful than a barium enema. Endoscopy also provides the opportunity to treat and diagnose the lesions.[24, 25]

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Histologic Findings

Histopathologic examination of skin blue rubber bleb nevus syndrome (BRBNS) lesions reveals vascular tissue with tortuous, blood-filled ectatic vessels, lined by a single layer of endothelium, with surrounding thin connective tissue. Dystrophic calcification may be present. See the image below.

Histopathology reveals blood-filled vessels, compoHistopathology reveals blood-filled vessels, composed of single layers of endothelium, surrounded by connective tissue.
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Contributor Information and Disclosures
Author

Basil S Cherpelis, MD Associate Professor, Chief of Dermatologic Surgery, Department of Dermatology and Cutaneous Surgery, Associate Professor, Department of Oncologic Sciences, University of South Florida College of Medicine; Consulting Staff, Moffitt Cancer Center, Tampa General Hospital, and James A Haley Veterans Affairs Medical Center

Basil S Cherpelis, MD is a member of the following medical societies: American Academy of Dermatology, American College of Mohs Surgery, American Society for Dermatologic Surgery, Association of Professors of Dermatology

Disclosure: Nothing to disclose.

Coauthor(s)

Neil Alan Fenske, MD Chairman, Department of Dermatology and Cutaneous Surgery, Professor, Department of Dermatology and Cutaneous Surgery, Department of Pathology and Cell Biology, Department of Oncologic Sciences, Medical Director, Health Cosmetic and Laser Center, University of South Florida College of Medicine

Disclosure: Received none from Abbvie for speaking and teaching; Received none from Valeant for speaking and teaching.

Hoka Lisa Nyanda, MD Academic Chief Resident, Department of Dermatology and Cutaneous Surgery, University of South Florida College of Medicine

Hoka Lisa Nyanda, MD is a member of the following medical societies: American Academy of Dermatology, American Academy of Pediatrics, American Medical Student Association/Foundation, Florida Medical Association, Southern Medical Association, Society for Pediatric Dermatology, Florida Chapter of The American Academy of Pediatrics, Florida Pediatric Society, Student National Medical Association

Disclosure: Nothing to disclose.

Specialty Editor Board

Richard P Vinson, MD Assistant Clinical Professor, Department of Dermatology, Texas Tech University Health Sciences Center, Paul L Foster School of Medicine; Consulting Staff, Mountain View Dermatology, PA

Richard P Vinson, MD is a member of the following medical societies: American Academy of Dermatology, Texas Medical Association, Association of Military Dermatologists, Texas Dermatological Society

Disclosure: Nothing to disclose.

Van Perry, MD Assistant Professor, Department of Medicine, Division of Dermatology, University of Texas School of Medicine at San Antonio

Van Perry, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD Professor and Chairman, Department of Dermatology and Dermatologic Surgery, Medical University of South Carolina College of Medicine

Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

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Multiple scattered blue to black rubbery papules and nodules involving the mid-chest region.
Purple to blue/black papules involving the upper and lower lips.
Multiple blue to black pigmented, rubbery, blood-filled sacs, which are easily compressible involving the GI tract.
Lower extremity cutaneous lesions described in blue rubber bleb nevus syndrome, consisting of blue rubbery papules and nodules with an easily compressible smooth surface.
Histopathology reveals blood-filled vessels, composed of single layers of endothelium, surrounded by connective tissue.
 
 
 
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