INDEX OF SUSPICION
Sanjiv B. Amin MD1
Jeffrey M. Devries MD, MPH2
Patricia McQuilkin MD3
Nathalie Quion MD3
Thomas G. DeWitt MD3
1 University of Rochester School of Medicine and Dentistry, Rochester, NY
2 Henry Ford Health System, Detroit, MI
3 University of Massachusetts Medical Center, Worcester, 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 15-year-old girl comes to your office complaining that she has experienced intermittent, sudden episodes of chest pain, fatigue, palpitations, and sensations of difficulty breathing and lightheadedness for 2 months. These episodes occur several times daily and are unaccompanied by other symptoms such as syncope, wheezing, swelling of the extremities, or fever. She denies being worried, but reports that her parents are very frightened because a 16-year-old male cousin died recently while playing soccer, and two other relatives, a 27-year-old cousin and a 29-year-old uncle, died suddenly during exercise.
The physical examination reveals a somewhat anxious girl complaining of mild precordial chest pain. Her temperature is 36.9°C(98.4°F) orally, respiratory rate is 16 breaths/min, heart rate is 110 beats/min, and blood pressure is 100/60 mm Hg; weight and height are at the 75th percentile.
