INDEX OF SUSPICION
William O. Robertson MD1
Vincent J. Menna MD
1 Children's Hospital and Medical Center, Seattle, WA
Editors: Lawrence R. Nazarian, MD.
Clinicians often form a diagnostic impression at the time of a patient's first consultation. Usually, the initial impression is correct because commonly encountered illnesses come to mind and are, of course, most likely to be responsible. Sometimes, however, a less familiar disorder is responsible and will not be detected or will be diagnosed only after a prolonged delay unless the physician maintains a suspicion of the unusual.
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
An 11-day-old infant — his mother's fourth — had an entirely normal delivery but was noted to be jaundiced on the fifth day of life. He was admitted to the hospital for phototherapy. The baby never had a bilirubin exceeding 17 mg/dL, but during the hospitalization he was diagnosed as having "apneic episodes" and was started on theophylline; he went home on that medication.
