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(Pediatrics in Review. 1997;18:357-360.)
© 1997 American Academy of Pediatrics

Index of Suspicion

This section ofPediatrics 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 a possible diagnosis 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 5-year-old Mexican-born girl now living in the United States is admitted to the pediatric ward because of an exacerbation of her asthma. She has had a fever for 6 days, and for the last 2 days has experienced shaking chills, shortness of breath, and wheezing. Her appetite has diminished, and an initial bout of diarrhea has been followed by constipation. For 3 days she has complained of dysuria. Her past history is significant only for asthma. She has had no known exposure to people who have infectious diseases or to animals and has not visited Mexico since age 3 years. Her immunizations are up to date.

On physical examination, the child is experiencing rigors and has a temperature of 39.7°C (103.5°F), pulse of 122 beats/min, respiratory rate of 36 breaths/min, and blood pressure of 122/65 mm Hg. Scattered wheezes are heard throughout her chest, and the expiratory phase is prolonged. Her abdomen is diffusely tender, especially in the suprapubic area, but there are no peritoneal signs. A complete blood count, urinalysis, and chest radiograph are normal. Blood and urine cultures are obtained, and the patient is monitored closely.

The abdominal pain progresses and migrates to the right lower quadrant. Ultrasonography of the abdomen reveals intraperitoneal fluid and hyperemic masses consistent with mesenteric adenitis; . . . [Full Text of this Article]