The patient had no history of related ...

13-year-old girl entered with a 2-month history of periodic swelling of soft tissue in her right upper extremity. Dermatological studies showed soft tissue crepitation and a small ulcer on the dorsum of the right hand. After several studies, including radiographic and systemic lasix to pass drug test blood diagnosis artificial subcutaneous emphysema was made and the patient was sent to psychiatry for Good Governance. Dermatitis artefacta well known, but, fortunately, a rare condition [,,,

]. This diagnosis of exclusion, because the clinical picture is consistent with known skin diseases, and no blood, no histological studies support the specific disease [

]. The diagnosis of this condition is very difficult, because several clinical aspects and fear no organic disease [

]. 13-year old girl came to our department with a 2-month history of recurrent ulcers and swelling of soft tissues in the right upper extremity. She noted that the ulcer and the tumor was on the right hand and forearm every 2 weeks and decided during the week. The patient had no history of associated systemic symptoms complained only subtle pain limited to these lesions. On examination, swelling and small ulcers were found on the back of his right hand, crepitation of tissue was present in heart (Fig. 1 and 2). .