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Visual Diagnosis

Visual Diagnosis. Rakesh D. Mistry, MD, MS Division of Emergency Medicine Children’s Hospital of Philadelphia. 8 mo. with fever and diaper rash. 8 mo. with fever and diaper rash. Differential Diagnosis Bullous impetigo S. aureus scalded skin Erysipelas Perianal group A strep

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Visual Diagnosis

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  1. Visual Diagnosis Rakesh D. Mistry, MD, MS Division of Emergency Medicine Children’s Hospital of Philadelphia

  2. 8 mo. with fever and diaper rash

  3. 8 mo. with fever and diaper rash Differential Diagnosis • Bullous impetigo • S. aureus scalded skin • Erysipelas • Perianal group A strep • Stevens-Johnson • Partial-thickness burn

  4. Erysipelas

  5. 10 y.o. male with rash on leg

  6. Local necrotizing skin infection Microbiology Streptococcus pyogenes (GABHS) S. aureus Pseudomonas aeurginosa Systemic Ecthyma gangrenosa Immune deficiency Ecthyma

  7. Ecthyma

  8. Bullous impetigo

  9. 4 y.o. girl with progressive facial swelling and fever

  10. Facial Swelling • Dental abscess • Facial cellulitis • Parotitis • Sinusitis • Lymphadenitis • Insect bite

  11. Another view…

  12. Facial Cellulitis • Microbiology • Staphylococcus aureus • Group A ß-hemolytic Streptococcus (GABHS) • Haemophilus tnfluenzae type B • Treatment: • Cephalosporins, clindamycin • Consider IV

  13. 6 y.o. male with fever, neck swelling, pain with eating

  14. Parotitis • Displaces ear • Obscures inferior border and angle of mandible • Microbiology • S. aureus • Oral flora • Infuenzae • Coxsackie/Enteroviruses • Mumps • HIV • Consider imaging for abscess

  15. Lymphadenitis • Microbiology • GABHS • H. influenzae • S. aureus • Oral flora • Treatment • Ampicillin/Sulbactam • Clindamycin • Consider imaging for abscess

  16. 12 mo. female with “rash”

  17. Popsicle Panniculitis • Extended contact with cold • Subcutaneous fat necrosis • Benign condition: Reassurance

  18. 5 y.o. girl with blood in underwear

  19. Urethral Prolapse • Pre-pubertal girls • Associated with constipation, increased abdominal pressure • Management • Sitz baths and reassurance • Topical estrogen cream • Urology follow-up

  20. 13 y.o female with 6 months of episodic abdominal pain

  21. Hematocolpos • Imperforate hymen • Primary amenorrhea • Abdominal mass • Treatment: Surgical

  22. Electrical Burn • Differential • Caustic ingestion • Infectious • Risk for delayed labial artery bleed

  23. 15 y.o. fever, sore throat, abdominal pain

  24. Differential Diagnosis GABHS N. gonorrhea Adenovirus Influenza Mononucleosis Epstien-Barr Virus (EBV) Cytolomegalovirus (CMV) Diagnosed GABHS (+) Placed on penicillin 15 y.o. fever, sore throat, abdominal pain

  25. Non-compliant…Returns in 5 days

  26. Peritonsillar Abscess • Older children and adolescents • “Hot-potato” voice • Trismus and drooling • Management • Needle aspiration • Antibiotic therapy

  27. 14 y.o. male with fever, neck pain, and dysphagia

  28. Ludwig’s Angina

  29. Ludwig’s Angina • Submandibular/sublingual infection • Rapidly progressive • Management • Monitor airway • IV antibiotics • Surgical drainage

  30. 18 mo. “not using hands”

  31. 18 mo. “not using hands”

  32. Vitamin D Deficiency • Hypocalcemia • Dietary • Skeletal findings • Bowing • Epiphyseal widening • “Rachitic rosary”

  33. 3 y.o. girl not using right arm

  34. Radial Head Subluxation • Typical appearance of well-appearing child not using affected arm • Reduction • Supination-Flexion • Pronation-Extension

  35. 8 y.o. female with fatigue and dyspnea on exertion for 2 weeks

  36. Pallor

  37. Typically appears with hemoglobin ~8 gm/dL Anemia Nutritional Blood loss Malignancy RBC destruction Anemia

  38. Infant with severe diarrhea

  39. Central Cyanosis • Severe pulmonary disease • Shock • R L cardiac shunt • Polycythemia • Abnormal hemoglobin states

  40. Oxidative stress: diarrhea, dehydration, acidosis Methemogobin cannot carry O2  tissue hypoxia Fluid resucitation Methylene blue Methemoglobinemia

  41. Fever and spreading rash

  42. Petechiae • Meningococemia • Viral exanthem • Rocky Mountain Spotted Fever (Rickettsia rickettsi) • Immune Thrombocytopenic Purpura • Mechanical

  43. 5 y.o. male casted 3 days ago for presumed fracture, now with rash

  44. Presentation Palpable purpura Joint swelling and pain Abdominal Pain Renal involvement Management Pain control Urinalysis Consider steroids Henoch-Schonlein Purpura

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