7 YO male bilateral lower abdominal pain Ultrasound Case studies in Comer’s Emergency Room

History Bilateral lower abdomen pain x 2 days Bilateral lower abdomen pain x 2 days No N/V/D No N/V/D No trauma No trauma No fever No fever No testicular pain No testicular pain History of eczema History of eczema

Physical exam Temp: 37.3, PR 103, RR 24, BP 116/74 Temp: 37.3, PR 103, RR 24, BP 116/74 Normal ENT/ Normal ENT/ Normal eye exam Normal eye exam Clear lungs Clear lungs Abdomen: Soft, redness,hyperpigmentation, crusting below the umbilicus Abdomen: Soft, redness,hyperpigmentation, crusting below the umbilicus Tender swollen inguinal lymph nodes with redness of the overlying skin Tender swollen inguinal lymph nodes with redness of the overlying skin Normal scrotum, testes & penis Normal scrotum, testes & penis No hernias No hernias

Abdomen/Skin examination Dry skin, rough surface Dry skin, rough surface Hyperpigmentation below umbilicus Hyperpigmentation below umbilicus Soft abdomen with no tenderness Soft abdomen with no tenderness Tender both inguinal ligaments Tender both inguinal ligaments Normal testes & scrotum Normal testes & scrotum

2D US of L inguinal area Enlarged L.N. Enlarged L.N. Hypo echoic Hypo echoic Size about 0.5 cm Size about 0.5 cm

2D US of R inguinal area

Doppler US They may show hilar vascularity but are usually hypovascular. They may show hilar vascularity but are usually hypovascular.

2D US appearance of normal/abnormal lymph node Flattened hypoechoic structures with varying amounts of hilar fat Flattened hypoechoic structures with varying amounts of hilar fat Enlarged hypoechoic swollen lymph node

Doppler US of L.N. Benign lymph node— power Doppler colour flow pattern. Note central flow pattern mirrors hilus. Benign lymph node— power Doppler colour flow pattern. Note central flow pattern mirrors hilus.

Management Patient was started on PO Clindamycin Patient was started on PO Clindamycin Treatment for local rash of eczema Treatment for local rash of eczema F/U with PMD F/U with PMD