Case presentation A 4-year-old female presents with the parents noting that the child has been “not walking right” and “wobbly” for the past 3 weeks. She sustained a head injury 1 month prior to her current presentation but there was no reported loss of consciousness at that time and the fall was off a chair, onto a hardwood floor, less than 2 feet. At the time,…
Case presentation A 6-year-old male with no significant medical history presents with headaches for the past 2 weeks. The headache is described as diffuse and, while occurring throughout the day, seems to be worse at night, at times waking him from sleep. He has also had daily first morning nonbilious, nonbloody emesis for the past week. There is no complaint of abdominal pain and there has…
Case presentation An 83-day-old female, with a history of congenital hydrocephalus and chronic subdural fluid collections, presents with a 1-week history of increasing fussiness and decreasing oral intake. She has a ventriculoperitoneal (VP) shunt that was placed soon after birth; there has been no revision of the shunt since placement. The mother reports to you that there has been no fever, vomiting, diarrhea, or rash, and…
Case presentation An 11-year-old female presents with severe right-sided abdominal pain that began 5 days ago. The patient reports that she was in her usual state of good health until she experienced the pain, which initially seemed generalized, intermittent, and achy but has become more constant, sharp, and now is located primarily in the right lower quadrant. She developed a fever to 102 degrees Fahrenheit 2…
Case presentation A 14-month-old female is referred from her primary care pediatrician for increasing abdominal girth and an abdominal mass. For the past month, the child’s abdomen has been increasing in size, as noted by her parents. There has been no associated fever, vomiting, diarrhea, trauma, back pain, urinary complaints, difficulty breathing, or cough. She is otherwise behaving at her baseline. Physical examination reveals a well-appearing…
Case presentation An 11-year-old male presents with acute onset of left-sided lower abdominal pain and left-sided flank pain, which began 1–2 hours prior to presentation. The patient was not engaged in any particular activity; he states that he was “just relaxing” when the pain began. He denies trauma. There has been no fever, back pain, dysuria, hematuria, testicular pain/swelling, or other abdominal pain. While he has…
Case presentation A 13-year-old female presents with acute onset of right lower quadrant pain for the past 4 hours. She states that she has been in her usual, normal state of health and was “just walking down the street” when she experienced the pain, which was accompanied by nausea and she has had three episodes of nonbilious/nonbloody emesis. She states that after the emesis, she feels…
Case presentation A 4-month-old male presents with bilateral scrotal swelling. Per the mother, this has been present since 1 month of age but has worsened over the past week and she has noted that the right side of the scrotum appears darker than normal. The mother also states that there has been mild congestion and cough for the past week and today the child developed a…
Case presentation A 15-year-old male presents with left scrotal pain and swelling for the past 5 hours. He states that he was jumping on a trampoline just prior to presentation and afterward, he experienced his symptoms. He denies genital trauma. He has not had fever, back pain, dysuria, hematuria, penile discharge, abdominal pain, or vomiting. He denies being sexually active. Physical examination reveals a well-appearing pleasant…
Case presentation A 3-week-old male presents with nonbilious, nonbloody emesis for the past 1.5 weeks. Initially there were two to three episodes per day, occasionally with feeding, but this has increased to emesis with every feed. The parents report that the emesis is “forceful” and afterward the child appears to want to eat again. He has had decreased urine output over the past 24 hours. There…
Case presentation A 4-year-old male presents to the emergency department after his parents witnessed the ingestion of a coin. His mother states that he grabbed one out of her purse that was lying on the ground nearby. The patient is resting comfortably in the room, in no acute distress. His lungs are clear to auscultation, there is no stridor, and he is managing his secretions. His…
Case presentation A 14-year-old male is brought to the emergency department with severe diffuse abdominal pain. He has had multiple episodes of nonbloody but bilious emesis accompanying the pain. There has been no fever, diarrhea, or trauma. There are no sick contacts or travel. He has had decreased oral intake of both solids and fluids due to nausea over the past 5 days. Notably, his weight…
Case presentation A 10-year-old male presents with 2 days of initially intermittent, now constant, abdominal pain. He states that the pain started on the right side of his abdomen and was crampy in quality, although now has become more sharp. The pain has now localized to the right lower quadrant, although he complains of radiation to the umbilicus and the right upper quadrant. He has not…
Case presentation A 15-month-old boy is brought into the emergency department by his parents for inconsolable crying for the last 6 hours. He has been crying and refusing to feed and has had nonbloody, nonbilious emesis twice. He is afebrile and his other vital signs are heart rate in the 160s beats per minute, respiratory rate of 30 breaths per minute, blood pressure of 107/89 mm…
Case presentation A 2-year-old male with a medical history of Hirschsprung disease requiring colectomy and ileo-anal pullthrough presents with multiple episodes of nonbilious emesis and no stool output over the past 24 hours. The mother states that she has noted that the child has had increased abdominal girth over the past 48 hours and has become fussy. He has had decreased oral intake. There has been…
Case presentation A 7-month-old male with a history of prematurity (27 weeks’ gestation) presents with a gastrostomy button that fell out approximately 3 hours prior to arrival. The child has had the gastrostomy button for 3 months. The mother tells you that the button “slipped out” during the child’s feeding. She attempted to replace the button but was unsuccessful. The child was seen at an outside…
Case presentation A 2-year-old female presents to the emergency department with wheezing and cough. The family states that she has had mild fever to 100.1 degrees Fahrenheit for the past 2 days. There has been no vomiting or diarrhea. She has been taking oral fluids well and is otherwise behaving at her baseline. Her physical examination reveals a well-appearing child in no respiratory distress. She has…
Case presentation A 7-week-old male presents with difficulty breathing while feeding for 1 day. The child is formula fed 3 ounces every 3–4 hours, but over the past 2–3 days, he has been feeding every 4 hours and not completing the 3 ounces. One day ago, he developed increased work of breathing while feeding and “turned pale for several seconds” according to the parents. There was…
Case presentation A 13-year-old male presents to the emergency department (ED) with 2 weeks of chest pain. He describes the pain as sharp and constant, worsening over the past week. Two weeks ago, the patient had fever to 102 degrees Fahrenheit and cough. He then developed sharp frontal chest pain that he described as “stabbing.” The pain worsened when lying down. He was seen by his…
Case presentation A 10-day-old infant presents to the emergency department with 1 day of fussiness, decreased oral intake, decreased urine output, and three grossly bloody stools. There has been no fever, cough, congestion, vomiting, or rash. The child is breastfed exclusively and the mother denies she has had cracked nipples or bleeding from the breast. She has noted the child is feeding less vigorously today. The…