Consultation with the Specialist
Cerebral Abscess and Congenital Heart Disease
William B. Strong MD
J.D. is a 3-year-old boy who has tetralogy of Fallot. His definitive correction has been deferred because of the parents' desire for bloodless surgery. Until 4 days prior to being seen in the office, he was in his usual state of health. He always has been reasonably active, and his oxygen saturation by transcutaneous pulsed oximetry has been in the mid-80% range. His last hemoglobin level, obtained 3 months ago, was 16.5 g/dL; his red blood cell indices were normal.
Four days prior to coming to the office he complained of a mild headache, and his mother thought he felt warm to the touch. He seemed to respond to acetaminophen therapy. Three days later, he again complained of headache, felt warm to the touch, and was not his usual active self. His mother stated that she thought he was coming down with the same virus from which his preschool brother had just recovered. He has not improved with acetaminophen, and he now appears more cyanotic and lethargic and complains of a severe left-sided headache.
Your examination reveals a sick-appearing child who is quite cyanotic and only moderately responsive to commands. His temperature is 38.8°C, pulse is 120 beats/min, respirations are 28/min and unlabored, and blood pressure is 96/58 mm Hg.
