We're unable to sign you in at this time. Please try again in a few minutes.
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Special Feature |

Radiological Case of the Month FREE

Rivital Sela, MD; Moshe Nussinovitch, MD; Nitsa Ziv, MD; Benjamin Volovitz, MD; Jacob Amir, MD; Beverly P. Wood, MD
[+] Author Affiliations

Section Editor: Beverly P. Wood, MD

Arch Pediatr Adolesc Med. 2001;155(11):1273-1274. doi:10.1001/archpedi.155.11.1273.
Text Size: A A A
Published online

A 3-YEAR-OLD BOY was referred for evaluation of unilateral testicular swelling and abdominal and lower limb edema. His mother reported that he had been coughing and vomiting for 3 weeks prior to admission. Swelling began 4 weeks before admission. Physical examination showed extensive peripheral edema and ascites. There was no fever and his blood pressure was 106/56 mm Hg.

Laboratory findings were as follows: white blood cell count, 26.3 × 109 (62.7% lymphocytes); hemoglobin, 14.4 g/dL; albumin, 1.7 g/dL; potassium, 4.7 mmol/L; sodium, 132 mmol/L; glucose, 107 mg/dL (5.94 mmol/L); normal urine protein and amylase content; positive urine cytomegalovirus antigen; positive cytomegalovirus antibody, IgM and IgG; and stool α1-antitrypsin level was 15.2 mg per gram of dry weight stool.

Abdominal ultrasound showed bilateral pleural effusions and a large quantity of intraperitoneal fluid, an enlarged liver, and markedly thickened gastric rugae (Figure 1).

The boy was treated with antibiotics for his cough, intravenous albumin and furosemide for edema, and a diet of protein-enriched food. The swelling subsided and the abdominal diameter decreased during the next several weeks.




Also Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Please click the checkbox indicating that you have read the full article in order to submit your answers.
Your answers have been saved for later.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.


Some tools below are only available to our subscribers or users with an online account.

0 Citations

Related Content

Customize your page view by dragging & repositioning the boxes below.

Articles Related By Topic
Related Collections

The Rational Clinical Examination: Evidence-Based Clinical Diagnosis
Evidence to Support the Update

The Rational Clinical Examination: Evidence-Based Clinical Diagnosis
Evidence Summary and Review 1