Pediatrics in Review
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(Pediatrics in Review. 2005;26:295-301.)
© 2005 American Academy of Pediatrics

Index of Suspicion

The first 300 words of the full text of this article appear below.


   Case 1 Presentation
 
A 16-year-old girl comes to the ED because of acute shortness of breath and "coughing up a cup of blood." She has been diagnosed as having asthma and uses bronchodilators as needed. Over the past 7 months, her cough and wheezing episodes have increased, and she has produced blood-streaked sputum but has not sought care. She denies any fevers, weight loss, lethargy, decreased appetite, unusual travel, or major illness.

On physical examination, she is uncomfortable and is breathing at 35 breaths/min but without respiratory distress. Her temperature is 98.5°F (37°C), heart rate is 96 beats/min, blood pressure is 129/66 mm Hg, and oxygen saturation is 95% by pulse oximetry. Breath sounds over the right hemithorax are diminished, but no retractions, wheezing, or crackles are noted. The remaining physical findings are normal.

Her Hgb concentration is 14.1 g/dL (141 g/L), WBC count is 14.6x103/mcL (14.6x109/L) (90% neutrophils, 5% lymphocytes, 5% monocytes), and platelet count is 183x103/mcL (183x109/L). Coagulation study results, serum electrolyte measurements, and liver enzyme values are normal. A chest radiograph reveals complete opacification of the right lung and the presence of a convex density in the right mainstem bronchus. CT scan of the chest demonstrates a mass in the right mainstem bronchus resulting in extensive atelectasis. A tuberculin skin test is applied, and sputum obtained for cell count, Gram stain, and culture. Ceftriaxone therapy is initiated.

Bronchoscopy is performed, and tissue specimens from the mass reveal the diagnosis.


   Case 2 Presentation
 
A 21-month-old boy known to have chronic gastroesophageal reflux is brought to your office for a second opinion regarding poor growth. Born at term, he was diagnosed as having reflux at 3 weeks of age due to arching and crying with feedings. He was noticed to be failing to . . . [Full Text of this Article]


Mark Puczynski, MD
Rama Jasty, MD
Nizar Kheralla, MD
 Medical College of Ohio, Toledo, Ohio

Laurie Liang, MD
 Kaiser Santa Clara Hospital, Santa Clara, Calif

Carrie Phillipi, MD, PhD
Laurie Christensen, MD
John Samples, MD
 Oregon Health and Science University, Portland, Or

Barry Hugo, MD
 Kennebunk, Me

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