INDEX OF SUSPICION

Abstract

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 previously healthy 6-month-old girl is seen at the office for evaluation of fussiness and infrequent urination. The child has not voided in the past 9 hours despite her usual fluid intake. She is afebrile, with no focus of infection found on careful physical examination. A palpable mass is felt in the suprapubic area. Her external genitalia are normal. Renal and pelvic ultrasonography reveal an echo-free area superior to a normal lower renal ureteral segment on the left side, with a circular echo free area at the lower end of the ureter extending into and taking up about one quarter of the space within a distended bladder. Case 2 Presentation A 4-year-old boy is seen in your office with a 4-day history of sore throat and low-grade fever.