RT Journal
A1 Narchi H, Santos M, Tunnessen WW, Jr
T1 PIcture of the month
JF Archives of Pediatrics & Adolescent Medicine
JO Archives of Pediatrics & Adolescent Medicine
YR 1999
FD September 1
VO 153
IS 9
SP 997
OP 997
DO 10.1001/archpedi.153.9.997
UL http://dx.doi.org/10.1001/archpedi.153.9.997
AB 
On physical examination, the infant appeared well nourished and had no dysmorphic features. She was irritable and cried constantly. Her respirations were 50/min with intermittent grunting; pulse, 160/min; and temperature, 37°C. Oxygen saturation was 97% by pulse oximetry. Her skin was pale and extremities cool. On chest examination there were mild intercostal retractions, clear lung fields to auscultation, and a grade 3/6 systolic murmur along the left sternal border with a loud second heart sound and a gallop rhythm. The abdomen was soft with the liver edge palpable 4 cm below the right costal margin. Pulse and blood pressure were equal in all 4 extremities. A chest x-ray film (Figure 1) and electrocardiogram (Figure 2) were obtained.