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Mineva G, Culleton E, Falusi T, Ryan D. Outcomes of abdominal pain among children presenting to the Emergency Department of a tertiary hospital in the Republic of Ireland before and during the COVID-19 pandemic. Ir J Med Sci 2024; 193:1033-1041. [PMID: 37851331 DOI: 10.1007/s11845-023-03547-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Accepted: 10/03/2023] [Indexed: 10/19/2023]
Abstract
BACKGROUND Acute abdominal pain in paediatric patients is a common presentation to the Emergency Department (ED). The COVID-19 pandemic had a significant impact on the health care sector leading to a decline in hospital attendance. AIMS We compare the burden of paediatric abdominal pain 1 year before and after the start of the COVID-19 pandemic in an Irish ED. METHODS A retrospective cohort study was conducted in a tertiary hospital. Ethical approval was obtained. Data was collected from January 1 to June 30, 2019, and 2021. Patients' charts were accessed using Therefore® software. Key variables were extracted and summarised in Microsoft Excel tables. Univariate and multivariate data analysis were conducted in SPSS® software. RESULTS Six hundred sixty-one (2019) and 479 (2021) patient records were evaluated. There was a 28% reduction in case presentations during pandemic months. Age group, sex and attending discipline were similar for both years. Rates of imaging were significantly higher in 2021 (22.5% vs. 10.6%). Overall admission rate was higher in 2021 (37% vs. 25%, p < 0.001). Viral gastroenteritis decreased (13%) and non-specific diagnosis increased (46%) in 2021. Fewer children re-presented in 2021 (13%). CONCLUSIONS The COVID-19 pandemic had an impact on the presentation, investigations and admission rates of abdominal pain in the ED. Our study highlights the need for increased awareness of severe abdominal pain signs and symptoms in paediatric patients and importance for diagnostic accuracy. Improving patient flow through the ED and having clear guidelines for staff and parents can optimise clinical practice and improve patient outcomes.
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Affiliation(s)
- Gabriela Mineva
- University Hospital Limerick, St Nessan's Road, Dooradoyle, Co. Limerick, V94 F858, Ireland.
- School of Medicine, University of Limerick, Limerick, V94 T9PX, Ireland.
| | - Emma Culleton
- University Hospital Limerick, St Nessan's Road, Dooradoyle, Co. Limerick, V94 F858, Ireland
- School of Medicine, University of Limerick, Limerick, V94 T9PX, Ireland
| | - Tolulope Falusi
- School of Medicine, University of Limerick, Limerick, V94 T9PX, Ireland
| | - Damien Ryan
- School of Medicine, University of Limerick, Limerick, V94 T9PX, Ireland
- ALERT, Emergency Department, University Hospital Limerick, St. Nessan's Road, Limerick, Ireland
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Beverstock A, Griesman D, Coren C, Leavens-Maurer J, Noyola E. Epigastric Pain and Pleural Effusion in a 12-Year-Old. Clin Pediatr (Phila) 2023; 62:664-668. [PMID: 36475387 DOI: 10.1177/00099228221142475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Andrew Beverstock
- Department of Pediatrics, NYU Langone Hospital Long Island, Mineola, NY, USA
| | - Dana Griesman
- Department of Pediatrics, NYU Langone Hospital Long Island, Mineola, NY, USA
| | - Charles Coren
- Department of Surgery, NYU Langone Hospital Long Island, Mineola, NY, USA
| | - Jill Leavens-Maurer
- Department of Pediatrics, NYU Langone Hospital Long Island, Mineola, NY, USA
| | - Estela Noyola
- Department of Pediatrics, NYU Langone Hospital Long Island, Mineola, NY, USA
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Mizumoto J, Shimizu T. All that glitters is not gold. J Gen Fam Med 2019; 20:180-184. [PMID: 31516803 PMCID: PMC6732497 DOI: 10.1002/jgf2.264] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Accepted: 05/09/2019] [Indexed: 12/02/2022] Open
Abstract
A 79-year-old Japanese woman presented with acute and diffuse abdominal pain, which turned out to be an unusual diagnosis. This article highlights a hint in physicians' diagnostic process, thereby avoiding the obstacles in making a correct diagnosis.
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Affiliation(s)
- Junki Mizumoto
- Department of Family PracticeEhime Seikyou HospitalEhimeJapan
| | - Taro Shimizu
- Department of Diagnostic and Generalist MedicineDokkyo Medical UniversityTochigiJapan
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The Burden and Outcomes of Abdominal Pain among Children Presenting to an Emergency Department of a Tertiary Hospital in Tanzania: A Descriptive Cohort Study. Emerg Med Int 2018; 2018:3982648. [PMID: 29862079 PMCID: PMC5971299 DOI: 10.1155/2018/3982648] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Accepted: 02/11/2018] [Indexed: 11/26/2022] Open
Abstract
Background Abdominal pain in children can represent benign conditions or life-threatening emergencies. Aetiologies of paediatric abdominal pain vary geographically and have not been studied in acute care settings in East Africa. This study describes the clinical profiles and outcomes of children presenting with undifferentiated abdominal pain to the Emergency Department of Muhimbili National Hospital (ED-MNH). Methods This was a prospective cohort study of children below 18 years of age presenting to the ED-MNH with abdominal pain. A structured case report form was used to collect data on patients from June to December 2016. Data included demographics, clinical presentation, and mortality. Data were summarised using descriptive statistics. Results Out of 1855 children who presented to ED-MNH, 184 (9.9%) met inclusion criteria, and all were enrolled. The median age was 3.5 years (IQR: 1.3–7.0 years) and 124 (67.4%) were male. Most (138 [75.0%]) were referred from peripheral hospitals. The most frequent ED providers' diagnoses were hernia (34 [18.5%]) and intra-abdominal malignancy (19 [10.3%]). From the ED, 37 (20.1%) were discharged home, 83 (45.1%) were admitted to medical wards, and 48 (26.1%) were admitted to surgical wards. 16 (8.7%) underwent an operation. 24-hour, seven-day, and three-month mortality rates were 1.1%, 6.5%, and 14.5%, respectively. The overall in-hospital mortality rate was 12.2%. Multivariate analysis showed that age below 5 years, female sex, and haemoglobin less than 10.9 g/dl were significant factors associated with in-hospital mortality. Discussion and Conclusion Abdominal pain is a common complaint among paediatric patients presenting to the ED-MNH. This presentation was associated with a high admission rate and a high mortality rate. Age below 5 years, female sex, and haemoglobin less than 10.9 g/dl were associated with mortality. Further studies and quality improvement efforts should focus on identifying aetiologies, risk stratification, and appropriate interventions to optimise patients outcomes.
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Lipsett SC, Neuman MI. Young Child With Abdominal and Back Pain. Ann Emerg Med 2016; 68:780-792. [DOI: 10.1016/j.annemergmed.2016.04.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Indexed: 10/20/2022]
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de Brito RDCCM, Lucena-Silva N, Torres LC, Luna CF, Correia JDB, da Silva GAP. The balance between the serum levels of IL-6 and IL-10 cytokines discriminates mild and severe acute pneumonia. BMC Pulm Med 2016; 16:170. [PMID: 27905908 PMCID: PMC5131553 DOI: 10.1186/s12890-016-0324-z] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2016] [Accepted: 11/17/2016] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND To identify markers for earlier diagnosis of severe pneumonia, we assess the correlation between serum cytokine profile of children with different pneumonia severity. METHODS In 25 hospitalized children, 7 with mild pneumonia and 18 with severe pneumonia, the serum concentration of 11 cytokines in three sampling times were dosed. Statistical analysis included parametric and non-parametric tests, Pearson correlation and ROC curve for cut-off definition of cytokines. RESULTS At admission, IL-6 serum levels were high in mild or severe pneumonia, and was associated to vomiting (P = 0.019) in both groups; and also to dyspnea (P = 0.012) and white blood cell count (P = 0.045) in patients with severe pneumonia. IL-10 levels were also high in patients with pneumonia and were associated to lymphocytosis (P = 0.025). The ROC curve of the IL-6:IL-10 serum levels ratio discriminated severe pneumonia cases at admission, and persistence of infection in the third day of antibiotic therapy, with positive predictive values of 93% and 89%, respectively. CONCLUSIONS The balance between IL-6 and IL-10 serum levels showed to be a more discriminative marker for severity definition and evaluation of recovery in patients with pneumonia.
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Affiliation(s)
- Rita de Cássia Coelho Moraes de Brito
- Institute of Integral Medicine Professor Fernando, Figueira (IMIP), Pediatrics, Rua Dona Benvinda de Farias 159, apt 1101, Boa Viagem, Recife, Pernambuco Brazil
| | - Norma Lucena-Silva
- Institute of Integral Medicine Professor Fernando Figueira (IMIP), Oncology and Aggeu Magalhães Research Center, Fiocruz-PE, Immunology, Recife, Brazil
| | - Leuridan Cavalcante Torres
- Institute of Integral Medicine Professor Fernando, Figueira, IMIP, Translational Medicine Laboratory, Recife, Brazil
| | | | - Jaílson de Barros Correia
- Institute of Integral Medicine Professor Fernando, Figueira, IMIP, Translational Medicine Laboratory, Recife, Brazil
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Brito RDCCMD, Guerra TCM, Câmara LDHLD, Mattos JDPGD, Mello MJGD, Correia JDB, Silva NL, Silva GAPD. Clinical characteristics and outcomes of acute community acquired pneumonia in children at a reference public hospital in Pernambuco State, Brazil (2010-2011). REVISTA BRASILEIRA DE SAÚDE MATERNO INFANTIL 2016. [DOI: 10.1590/1806-93042016000300003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Abstract Objectives: to describe the clinical characteristics and outcomes of acute community acquired pneumonia in children at a reference public hospital in Pernambuco State, Brazil (2010-2011) Methods: pneumonia case series of 80 children aged 28 days to 14 years old at Hospital da Restauração in Pernambuco, Brazil, from 2010 to 2011. Information was noted from medical files, and two comparison groups were created according to the severity of the disease, considering the presence of pleural effusion. Fisher or Mann-Whitney tests were used for comparative analyses. Results: severe pneumonia with pleural effusion was more frequent in children under five years of age (p=0,025), and was associated with longer period of fever (19 x 15 days) and coughing (17 x 13 days), when compared to non-complicated pneumonia cases. Six children (7,5%, 6/80) died, 50% before the fourth day of hospitalization (p=0,001). All deaths were from the pleural effusion group in children from the countryside (p=0,026). Conclusions: the severity of pneumonia in children attended at this hospital is related to younger children, and those transferred from the health units in the countryside, so, early diagnosis and medical intervention are limited by infrastructure and available resources for the health.
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Kim Y, Moon SB. Acute intestinal obstruction requiring surgery in pediatric malignancies: Summary of 7 cases. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2015. [DOI: 10.1016/j.epsc.2015.05.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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El-Radhi AS. Management of abdominal pain in children. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2014; 24:44-7. [PMID: 25541876 DOI: 10.12968/bjon.2015.24.1.44] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Abdominal pain (AP) is a very common complaint caused by a variety of conditions. Mild or moderate AP affects practically all children of all ages. The pain usually settles spontaneously without medical intervention. AP severe enough to require medical intervention has both surgical and non-surgical causes. It is responsible for considerable morbidity, missed school days, and significant use of health resources. Children usually present either with an acute or recurrent AP. In comparison, chronic AP with persistent symptoms, lasting days or weeks, is rare in children. Surgical conditions may be the underlying causes in acute AP, but non-surgical conditions are diagnosed more commonly in children with recurrent AP. Management can be difficult, time-consuming and often clinically challenging to diagnose and treat. In most instances, the cause of AP can be diagnosed through the history and physical examination. The main objective in managing an affected child is to differentiate between benign, self-limited conditions such as constipation or gastroenteritis, and more life-threatening surgical conditions such as intussusception or appendicitis. Irritable bowel syndrome (IBS) and Crohn's disease should be considered in any child presenting with recurrent AP.
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Affiliation(s)
- A Sahib El-Radhi
- Consultant paediatrician, Chelsfield Park Hospital, Kent, Honorary consultant paediatrician, Queen Mary's Hospital, Honorary senior lecturer, King's College London
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Hemoperitoneum: an unusual presentation of chronic granulocytic leukemia in a pediatric patient. Pediatr Emerg Care 2014; 30:418-20. [PMID: 24892682 DOI: 10.1097/pec.0000000000000152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Chronic granulocytic leukemia (CGL) is a rare hematologic disease in pediatric patients. It usually presents with insidious symptoms. However, some cases may have an atypical presentation. We report herein the case of a 13-year-old female admitted to the emergency department with acute abdomen. She had hyperleukocytosis of 500.0 × 1000 cells/mm suggestive of CGL. A paracentesis was performed due to abdominal compartment syndrome that demonstrated hemoperitoneum. At laparotomy, a ruptured ovarian mass was found with multiple tumor implants in the serosal surface. Pathology revealed a CGL-infiltrated ovary. The patient is currently stable, has finished adjuvant chemotherapy, and is at 24 months of follow-up. To our knowledge, this is the first report of such a case.
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Chen TH, Tseng YH, Tseng CM, Chiang HH, Lin TJ. Spontaneous hemopneumothorax simulating acute abdominal affections. Pediatr Pulmonol 2014; 49:E1-4. [PMID: 23169600 DOI: 10.1002/ppul.22712] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2012] [Accepted: 10/02/2012] [Indexed: 11/06/2022]
Abstract
Spontaneous hemopneumothorax (SHP) is a rare potentially life-threatening condition that occurs in predominantly young adolescents. The resultant massive hemorrhage leading to hypovolemic shock can be a surgical emergency. It constitutes 1-12% of all spontaneous pneumothoraces and presents with two cardinal features, chest pain and dyspnea. However, the pain of SHP may be confined to the abdomen secondary to the irritation of diaphragmatic pleura, which produces signs simulating an acute abdomen. SHP masquerading as an abdominal affection is apparently regarded as extremely rare. We present a case of a 16-year-old male with SHP presenting features simulating acute gallbladder disease. After prompt diagnosis with appropriate surgical intervention, he had an uneventful recovery. Our experience emphasizes the importance of careful and thorough chest examination for each child with atypical pictures for abdominal pain to exclude possible extra-abdominal lesions, even rare as SHP.
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Affiliation(s)
- Tai-Heng Chen
- Department of Pediatrics, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; Division of Pediatric Emergency, Department of Emergency, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
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Abstract
We present the case of a child who showed acute abdominal pain and fever due to retrocardiac pneumonia by Streptococcus pneumoniae without respiratory signs and symptoms. Acute abdominal pain is a common presenting symptom of children seen in pediatric emergency rooms. Basilar pneumonia is an uncommonly known cause of pediatric abdominal pain; it may go unrecognized on a patient's initial evaluation. Our case suggests that the clinical manifestations of a retrocardiac pneumonia can be atypical with abdominal pain as the principal complaint, mimicking acute abdomen.
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Armeni E, Mylona V, Karlis G, Makrygiannis E. Pneumonia presenting with lower right abdominal pain and migratory polyarthritis. Respir Med Case Rep 2012; 5:29-30. [PMID: 26057353 PMCID: PMC3920392 DOI: 10.1016/j.rmedc.2011.11.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2011] [Accepted: 11/09/2011] [Indexed: 11/26/2022] Open
Abstract
The clinical presentation of community acquired pneumonia (CAP) in adults includes mainly symptoms from the respiratory system, whereas CAP is considered as a main cause of abdominal pain in pediatric patients. We present the case of a patient, who was admitted to our hospital due to abdominal pain that deteriorated progressively and radiated to the lumbar region. The clinical examination revealed decreased breath sounds at the right lung base after 72 h, while the chest X-ray showed pneumonia of the right lung base. The blood culture isolated Streptococcus pneumoniae, and the patient received penicillin according to the results of the antibiogram. In addition, the patient developed symptoms of migratory arthritis, which resolved after 48 h. CAP should be included in the differential diagnosis of abdominal pain in adult patients. Furthermore, the hematogenous spread of S. pneumoniae may be associated with the development of migratory arthritis.
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Affiliation(s)
- Eleni Armeni
- Sismanogleiou 1 Ave, 2nd Department of Internal Medicine, Sismanogleio Hospital, Athens, Greece
| | - Vasiliki Mylona
- Sismanogleiou 1 Ave, 2nd Department of Internal Medicine, Sismanogleio Hospital, Athens, Greece
| | - George Karlis
- Sismanogleiou 1 Ave, 2nd Department of Internal Medicine, Sismanogleio Hospital, Athens, Greece
| | - Elias Makrygiannis
- Sismanogleiou 1 Ave, 2nd Department of Internal Medicine, Sismanogleio Hospital, Athens, Greece
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Abstract
Abdominal pain is one of the most common reasons pediatric patients seek emergency care. The emergency physician must be able to distinguish diagnoses requiring immediate attention from self-limiting processes. Pediatric patients can be challenging, particularly those who are preverbal, and therefore, the clinician must rely on a detailed history from a parent or caregiver as well as a careful physical examination in order to narrow the differential diagnosis. This article highlights several pediatric diagnoses presenting as abdominal pain, including surgical emergencies, nonsurgical diagnoses, and extraabdominal processes, and reviews the clinical presentation, diagnostic evaluation, and management of each.
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Affiliation(s)
- Jennifer R Marin
- Division of Emergency Medicine, Department of Pediatrics, Children's Hospital of Pittsburgh, Pittsburgh, PA 15224, USA.
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Alazzawi S, De Rover WS, Morris-Stiff G, Lewis MH. Erect chest radiography in the setting of the acute abdomen: essential tool or an unnecessary waste of resources? Ann R Coll Surg Engl 2010; 92:697-9. [PMID: 20650038 PMCID: PMC3229383 DOI: 10.1308/003588410x12699663904998] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/28/2010] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION It has been suggested that changes to the training schemes of junior doctors and the increased pressure on emergency departments to manage their patients within a limited time might increase the number of unnecessary investigations performed on emergency admission patients. This, in turn, may lead to an increased number of investigations with normal results. In this study we try to analyse the role of the chest X-ray (CXR) as a diagnostic tool in patients presenting with acute abdominal pain. PATIENTS AND METHODS A retrospective study was performed of the request forms and results of all chest radiography performed on patients admitted on the emergency surgical intake with acute abdominal pain through utilisation of the prospectively maintained electronic radiology database. The indications were compared to the guidelines published by the Royal College of Radiologists (RCR) which have been adopted as the standard of care. RESULTS A total of 334 chest X-rays were identified of which only 23 (7%) had new findings. Four (1%) patients had free gas under the diaphragm. Of the CXRs, 258 (77%) were reported normal whilst 53 (16%) had old changes which were described in their hospital records and previous radiographs. Of the CXRs with new findings, only 20 were clinically significant and, of these, four (1%) were surgically significant. CONCLUSIONS The majority of CXRs performed on emergency surgical admissions with abdominal pain are unnecessary. By obtaining a clear history, performing a thorough clinical examination and following the RCR guidelines most of the CXRs could be avoided. This would lead to less radiation exposure, reduce delays to diagnosis, and provide significant financial savings.
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Affiliation(s)
- S Alazzawi
- Department of Surgery, Royal Glamorgan Hospital, Llantrisant, UK
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Chen HP, Liu WY, Tang YM, Wang XJ, Xu B. An unusual presentation of thoracic para-aortic hematoma due to blunt trauma. Indian J Pediatr 2010; 77:809-10. [PMID: 20589478 DOI: 10.1007/s12098-010-0103-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2010] [Accepted: 04/06/2010] [Indexed: 02/05/2023]
Abstract
An 11-yr-old boy was admitted to the hospital with gradually aggravating acute abdominal pain along with nausea, vomiting and constipation for 5 days. The pain started after blunt trauma on the superior abdomen. He had normal laboratory tests and abdominal examination, but his chest radiograph showed infiltration in the right lung and an abnormal mass on the left diaphragm. Further investigation like computed tomography (CT) and magnetic resonance MR angiography, revealed an abnormal para-aortic mass located a mass located para-aortic above posterior to the left diaphragm with a well-defined margin. The abnormal mass was finally confirmed to be a hematoma with exploratory thoracotomy. The rarity of this kind of presentation is discussed for making an early and correct diagnosis.
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Affiliation(s)
- Hou-Ping Chen
- Department of Pediatric Surgery, West China Hospital of Sichuan, University, Chengdu, China
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