Pediatric Case COnference - Dr. Lawson

Abdominal Pain of Unusual Cause

• Abdominal pain in children is not always AGE, appendicitis, or UTI - keep your differential broad and use your exam skills (including GU and Tanner staging)
• "Smokiness" on ultrasound may be due to blood (RBCs scattering sound waves) or stasis
• Hematocolpos as a result of imperforate hymen can cause abdominal pain and urinary retention

PE vs Sepsis

• PE is a rare occurrence in children and often presents atypically (classic symptoms often only present in large PEs)
• Adult clinical decision rules (Wells Criteria and PERC) do not reliably apply to children
• Obesity, OCP use, and previous thrombus (not PE) are the three leading risk factors for PE
• History of central venous line is the most important predisposing cause of DVT
• Several studies other than CTA can help lessen your suspicion for PE (CXR, EKG, cardiac echo, extremity DVT US, BNP, troponin)

• Sepsis in children can be subtle and precipitous

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