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(Pediatrics in Review. 2007;28:225-229.)
© 2007 American Academy of Pediatrics

Index of Suspicion

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

	Case 1 Presentation

 
A 6-year-old boy is admitted to the hospital because of right groin pain and refusal to bear weight. Yesterday, the child was seen in the ED because of pain in the right inguinal area, limp, and a history of rash along the right popliteal fossa that was not present at the time of his evaluation. Doppler ultrasonography of the testicles, radiographs of the hip, CBC, and ESR all yielded normal results. He was diagnosed as having hip strain and instructed to take ibuprofen and to return if his symptoms worsened or he developed a fever. He returns today, having a temperature of 102.6°F (39.3°C) and refusing to bear weight.

On physical examination, the boy looks well but holds his right hip in an abducted, flexed, externally rotated position; refuses to move the leg; and complains of pain in the inguinal region. His temperature is 99.5°F (37.5°C), respiratory rate is 28 breaths/min, heart rate is 105 beats/min, and oxygen saturation on room air is 95%. Limb lengths and knee evaluation results are normal. There is no spinal tenderness, paraspinal muscle spasm, or lymphadenopathy. The other physical findings are normal.

His WBC count is 13x10³/mcL (13x10⁹/L), Hgb is 11.9 g/dL (119 g/L), platelet count is 221x10³/mcL (221x10⁹/L), ESR is 33 mm/h, C-reactive protein (CRP) is 156 mg/L (normal, 0 to 3 mg/L), and creatinine phosphate kinase (CPK) concentration is 200 U/L (normal, 55 to 170 U/L). Findings on urinalysis are normal. An imaging test reveals the diagnosis.

	Case 2 Presentation

 
A 6-week-old boy is seen in the ED because of acute respiratory distress. He was well until this evening, when he started making a "funny noise" with each breath, was working hard to breathe, and felt warm.

On arrival, the boy is in . . . [Full Text of this Article]

Harsha Bhagtani, MD
Eva Love, MD
Genta Baci, MD
Robert B. Boughan, MD
Scott D. Krugman, MD, MS
John Podraza, MD
Rees L. Lee, MD
Franklin Square Hospital, Baltimore, Md
Naval Medical Center, Portsmouth, Va

Tuc T. Nguyen, MD
Eugenia Charles, MD
Inova Fairfax Hospital for Children, Falls Church, Va

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