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INDEX OF SUSPICION

John L. Green MD Michael Shannon MD1
Frederick H. Lovejoy Jr MD Catherine DeAngelis MD 1 Children's Hospital, Boston, MA

This section of Pediatrics in Review reminds clinicians of those conditions that can present in a misleading fashion and require suspicion for early diagnosis. Emphasis has been placed on conditions in which early diagnosis is important and that the general pediatrician might be expected to encounter, at least once in a while. The reader is encouraged to write possible diagnoses for each case before turning to the discussion, which is on the following page.

We invite readers to contribute case presentations and discussions.

Case 1 Presentation

A 12-y-old boy is seen several hours after the onset of rather severe scrotal discomfort. The pain began shortly after the gym class in which an errant basketball pass struck him squarely in the scrotal area. He is in obvious pain, complains of nausea, and vomited on the car ride to your office. On examination, there is swelling and erythema of the left hemiscrotum and any movement or palpation of the left testis causes great pain; gentle elevation of the testis brings no pain relief. The testis is of firm consistency and quite tense. A cremasteric reflex cannot be elicited on the left side.

Case 2 Presentation

A 12-y-old boy is brought to the office with a 3- to 4-d history of intermittent headache and lethargy.






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Copyright © 1992 by the American Academy of Pediatrics.