![]() Biopsy of the mass confirmed the diagnosis. Abdominal MRI suggested a diagnostic category ( Figure 7-2). The abdominal radiograph revealed a large amount of stool.Ī fleets enema was given with good results, but the mass was still palpable. ![]() The uric acid was 5.3 mg/dL and the lactate dehydrogenase, 747 U/L. Electrolytes, blood urea nitrogen, creatinine, calcium, magnesium, and phosphorus were normal. The hemoglobin was 14.3 g/dL and the platelet count was 251 000/mm 3. Laboratory analysis revealed 11 500 WBCs/mm 3 with 2% band forms, 62% segmented neutrophils, 24% lymphocytes, and 9% monocytes. She was a Tanner I female with no inguinal lymphadenopathy. Rectal examination revealed good rectal tone and the rectal vault was full of stool which was negative for occult blood. The mass had sharp borders, was approximately 6 cm × 4 cm, and was slightly mobile. On palpation, the abdomen was nontender, but a firm mass was felt in the periumbilical region and left upper quadrant. The abdominal examination revealed normal bowel sounds. The lungs were clear and there was an I/IV systolic ejection murmur at the left lower sternal border. There was shotty cervical lymphadenopathy with enlarged superior cervical lymph nodes that were mobile and nontender. The tonsils were 2+ bilaterally with mild erythema of the posterior pharynx. Physical examination revealed an alert, well nourished, and interactive child. Weight 22.9 kg, 70th percentile Height 120 cm, 70th percentile She was treated with isoniazid for 9 months. Three years prior, she was exposed to tuberculosis and had a positive tuberculin skin test. She had mild asthma but no hospitalizations. Her primary care physician reportedly felt stool in the abdomen and started her on prune juice which she stopped using regularly.īirth history was normal with no complications at delivery or birth. The parents reported that about six months ago the patient had an episode of abdominal pain. She has had a good appetite and no weight loss. Her parents also reported that she has had ear pain and a sore throat for the past 3 days. The patient pointed to the periumbilical area when describing her pain. On the day of presentation she had two bouts of nonbloody, nonbilious emesis and continued to have fever as high as 103☏. CASE 7-2 Five-Year-Old GirlĪ 5-year-old female was well until 2 days prior to presentation when she developed emesis and fever. Symptom-Based Diagnosis in Pediatrics (CHOP Morning Report) 1st Ed.
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