A term, large-for-gestational age boy is transferred from an outside hospital with a right anterior chest wall mass noted since birth. His mother is a healthy 33-year-old gravida 4, para 4 woman with good prenatal care and normal prenatal laboratory values who had an uncomplicated pregnancy and elective cesarean delivery. None of the patient’s siblings or family members have had similar masses.

On physical examination the patient is well-appearing and moving all 4 extremities spontaneously without obvious limitations. Vital signs on admission to the hospital are normal. There is a nontender, boggy, fluctuant, flesh-colored, grapelike mass from his right nipple to the midaxillary line that extends to the right upper arm, with dimpling of the skin throughout the right upper extremity (Fig 1). No bruit is heard over the lesion. There is no palpable bony abnormality. Radial pulses are 2+. Capillary refill is less than 2 seconds. His...

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