M&M - Dr. Reyner

PE in PEDs

• PE is a rare disease process but is under-diagnosed!
• Predisposing risk factors include: malignancy, indwelling line, OCP usage, known DVT, thrombophilia, malignancy, congenital heart disease
  
• PE is becoming more common since children are living much longer with repaired congenital heart defects. 
  
• Clinical Decision Rules are not applicable in children.
• D dimer has not been shown to be useful in determination of pre test probability for PE. 
• ECG findings in acute PE with pulmonary HTN: Look for T wave inversions in anterior and inferior leads. 
• Juvenile T wave inversions typically involve leads V1-V3, but can involve V4- V6. 
• Red flags when looking at T wave inversions: Symmetric or deep. Juvenile T wave inversions should be asymmetric. 

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Oral Lichen Planus

• White reticular lace like pattern on the bilateral buccal mucosa. 
  
• Extremely painful.  
  
• Commonly seen in HCV+ patients. 
  
• Treat with buccal steroids and magic mouth wash for pain relief. 
  

URachal Cyst

• Think of infected urachal cyst in patients with periumbilical abdominal pain, periumbilical mass, fever, and dysuria. 
  
• Infected urachal cysts are ultimately managed with surgical removal.