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7 YO male bilateral lower abdominal pain. Ultrasound Case studies in Comer’s Emergency Room . History . Bilateral lower abdomen pain x 2 days No N/V/D No trauma No fever No testicular pain History of eczema. Physical exam. Temp: 37.3, PR 103, RR 24, BP 116/74 Normal ENT/
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7 YO male bilateral lower abdominal pain Ultrasound Case studies in Comer’s Emergency Room
History • Bilateral lower abdomen pain x 2 days • No N/V/D • No trauma • No fever • No testicular pain • History of eczema
Physical exam • Temp: 37.3, PR 103, RR 24, BP 116/74 • Normal ENT/ • Normal eye exam • Clear lungs • Abdomen: Soft , redness ,hyperpigmentation, crusting below the umbilicus • Tender swollen inguinal lymph nodes with redness of the overlying skin • Normal scrotum, testes & penis • No hernias
Abdomen/Skin examination • Dry skin, rough surface • Hyperpigmentation below umbilicus • Soft abdomen with no tenderness • Tender swellings @ both inguinal ligaments • Normal testes & scrotum
2D US of L inguinal area • Enlarged L.N. • Hypo echoic • Size about 0.5 cm
They may show hilar vascularity but are usually hypovascular . Doppler US
Flattened hypoechoic structures with varying amounts of hilar fat Enlarged hypoechoic swollen lymph node 2D US appearance of normal/abnormal lymph node
Doppler US of L.N. • Benign lymph node—power Doppler colour flow pattern. Note central flow pattern mirrors hilus.
Management • Patient was started on PO Clindamycin • Treatment for local rash of eczema • F/U with PMD