Young Child With Abdominal and Back Pain

IMAGES IN EMERGENCY MEDICINE Susan C. Lipsett, MD; Mark I. Neuman, MD 0196-0644/$-see front matter Copyright © 2016 Published by Elsevier, Inc on behalf of the American College of Emergency Physicians. http://dx.doi.org/10.1016/j.annemergmed.2016.04.012

Figure 1. Supine abdominal radiograph. Figure 2. Upright abdominal radiograph.

[Ann Emerg Med. 2016;68:780.] A previously healthy 3-year-old girl presented to the emergency department with abdominal and back pain. The family reported fever, nasal congestion, and cough for the past 3 days, and abdominal pain and back pain which began that day. Associated symptoms included decreased appetite and several episodes of nonbloody nonbilious emesis. Review of systems was negative for dysuria, hematuria, or urinary frequency. Vital signs revealed a blood pressure of 104/68 mm Hg, pulse rate of 160 beats/min, respiratory rate of 60 breaths/min, temperature of 38.6 C (101.5 F), and oxygen saturation of 98% on room air. Physical examination result was notable for a tachypneic and mildly dehydrated child. Auscultation of the lungs revealed no adventitial sounds, and the abdomen was soft, with focal right-upper-quadrant tenderness. Supine and upright abdominal radiographs were obtained (Figures 1 and 2), leading to the diagnosis.

For the diagnosis and teaching points, see page 792. To view the entire collection of Images in Emergency Medicine, visit www.annemergmed.com 780 Annals of Emergency Medicine

Volume 68, no. 6 : December 2016

792 Annals of Emergency Medicine

Volume 68, no. 6 : December 2016