Courtesy of Sesame Street
Abby, a 12 month old girl is brought to Sesame Children’s Hospital
by her parents after being admitted by her pediatrician.
Abby’s parents tell you about a little girl who was delivered by C-section
preterm but has been otherwise healthy until about a week ago. “We thought
she was just gaining wait and growing, but then she stopped eating so much
and continued to swell up,” explains her mom. The child had a red birthmark on the
abdomen, which has faded some since she was born.
The baby’s vitals are: pulse 140 bpm, blood pressure 120/55,
respirations 50, and temperature of 98.8 F.
On physical examination you note the child appears unwell, is tachypnic,
has generalized edema and a protuberant abdomen.
and has generalized edema without a fluid wave.
Her dad tells you, “We’ve also noticed changes in her birthmark.”
The birthmark is red and raised compared to the skin around it.
The liver edge is seven cm below the costal arch.
The neck veins are full but there is little hepatojugular reflux. There is no fluid wave.
Auscultation of her chest and abdomen are significant for tachycardia
and crackles bilaterally due to pulmonary edema.
There is a loud continuous hum heard over the liver.
After reassuring her parents, you leave the room to discuss the case with your preceptor.
After listening to your findings Dr. Grover says, “We need to find the cause of
enlarged liver nad increased cardiac output. Focus on her enlarged liver and give me a
working differential diagnosis.”
This is a real patient presentation, though the names have been fictionalized.
Which of the following do you think accurately describe the child's health?