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 ......
Article |

Radiological Case of the Month

John L. Gwinn, MD; Fred A. Lee, MD; Stuart B. Paster, MD; Richard E. Swensson, MD
Am J Dis Child. 1977;131(1):89-90. doi:10.1001/archpedi.1977.02120140091015.
Text Size: A A A
Published online


Clinical History.—A boy aged 13 years and 9 months was referred to the University of New Mexico Medical Center because of increasing dyspnea on exertion, shortness of breath, orthopnea, and a 6.4-kg weight gain over a period of four days. He had been experiencing congestive heart failure for at least one year, but came to the hospital because of exacerbation of symptoms.

Physical Examination.—The temperature was 37.3 C; the pulse rate, 112 beats per minute; respiratory rate, 28/min; and blood pressure, 120/70 mm Hg. Bilateral rales were heard. Examination of the heart revealed diffuse hyperactivity, sustained point of maximum intensity in the anterior axillary line with a right ventricular lift, as well as a grade 2/6 holosystolic murmur over the precordium, maximal at the lower left sternal border with radiation to the apex but not the axilla. The liver was down 4 cm. There was 4 + pitting edema


Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

First Page Preview

View Large
First page PDF preview





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

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

Related Content

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