Journals Periodicals 2018 Page 9 Pediatrics in Review®

Pediatrics in Review is the best-selling, clinically focused review journal from the AAP, trusted by thousands of pediatricians for the latest best practices in the world of pediatric medicine! Review articles Challenging online CME quizzes Exclusive online-only case reviews, and audio and video content Index of Suspicion Cases Visual Diagnosis Cases In Brief articles Teaching Slides Online and Print Nonmember: $270 // Member: $215 Online-Only Nonmember: $210 // Member: $165 shop.aap.org/2018-Pediatrics-in-Review Journal Features pedsinreview.org The annual subscription term for Pediatrics in Review is on a calendar basis, January through December. Subscribers have access to full text articles and CME quizzes for up to 3 years from the purchased product year. To earn MOC Part 2 credits, you will need to complete 2017 or 2018 journal CME quizzes. 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For questions about how to access this activity, contact MOCPortfolio@aap.org or visit aappublications.org/ content/moc-credit. pedsinreview.org An 11-year-old Boy with Right Thigh Swelling Delia Gold, MD,* Pam Horn, FNP, Patrick Warren, MD, Matthew Beran, MD x *Department of Emergency Medicine, Department of Orthopedics, Department of Radiology, and x Department of Sports Medicine, Nationwide Children s Hospital, Columbus, OH PRESENTATION An 11-year-old boy presents to the emergency department (ED) for a right thigh injury. Six weeks before presentation he was riding a large all-terrain vehicle (ATV) witharollcagewhenhecrashedand ippedtheATV.Therollbarhithisrightthigh, and he remembered it sliding from his distal to proximal thigh anteriorly. He was taken to a local hospital for treatment at that time. He had substantial swelling and pain;however,therewerenoopenwoundsandminimalabrasions.Radiographsof the femur at that visit were negative for fracture. He was diagnosed as having a simple hematoma and discharged. He had been instructed to use a compressive elastic wrap around his thigh, apply ice intermittently for several days, and walk with crutches until follow-up with his primary care physician (PCP). The patient followed up with his PCP 4 days after the injury complaining of worsening swelling, bruising, and pain. The patient reported that he had not followed the hospital discharge instructions. Due to worsening symptoms at his PCP visit, a magnetic resonance image (MRI) was obtained 5 weeks after the injury. After reviewing the MRI results, the PCP referred the patient to an orthopedic surgeon, who recommended the patient go to the ED for an immediate evaluation. On arrival at the ED, the patient is comfortable and in no distress. His only complaint is right thigh pain and swelling. On examination, the patient has normal vital signs and denies fever. He has no dif culty with a straight leg raise and has an intact extensor mechanism. He has full range of motion of his right hip, knee, ankle, and toes. He has 5/5 motor strength, and sensory function is found to be intact. His distal capillary re ll is less than 2 seconds, with easily palpable dorsalis pedis and posterior tibial pulses. He has no right knee or hip pain. Notably, he has a large, super cial, mobile uid collection along his right anterior/lateral thigh with several nonpainful, small, erythematous nodules. He has substantial swelling of this area, with positive ballottement along the en- tire anterior and lateral thigh extending down to the knee. There is resolving ecchymosisalonghisanteriorthightohisgroin.Hehasveryscanterythematothe proximal anterior thigh, without warmth to touch or pain with palpation. He has multiple bug bites on all 4 limbs. On standing, the uid collection pools distally due to gravity (Fig 1). The patient is noted to have a normal gait. The rest of his physical examination ndings are within normal limits. The previous femur radiographs and MRI scans are reviewed, and an ultraso- nographic image of his right leg is ordered (Figs 2-5). The image reveals a large AUTHOR DISCLOSURE Drs Gold,Warren,and BeranandMsHornhavedisclosedno nancial relationships relevant to this article. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device. Vol. 38 No. 12 DECEMBER 2017 e45 by guest on January 10, 2018 http://pedsinreview.aappublications.org/ Downloaded from g MD,* Pam Horn, FNP, Patrick Warren, MD, Matthew Beran, MD x f Emergency Medicine, Department of Orthopedics, Department of Radiology, and Sports Medicine, Nationwide Children s Hospital, Columbus, OH TION N ld boy presents to the emergency department (ED) for a right thigh eeks before presentation he was riding a large all-terrain vehicle (ATV) gewhen hecrashed and ipped theATV.Therollbar hit hisrightthigh, embered it sliding from his distal to proximal thigh anteriorly. He was cal hospital for treatment at that time. He had substantial swelling and er,therewerenoopenwoundsandminimalabrasions.Radiographsof t that visit were negative for fracture. He was diagnosed as having a atoma and discharged. He had been instructed to use a compressive around his thigh, apply ice intermittently for several days, and walk es until follow-up with his primary care physician (PCP). ent followed up with his PCP 4 days after the injury complaining of swelling, bruising, and pain. The patient reported that he had not e hospital discharge instructions. Due to worsening symptoms at it, a magnetic resonance image (MRI) was obtained 5 weeks after After reviewing the MRI results, the PCP referred the patient to dic surgeon, who recommended the patient go to the ED for an evaluation. al at the ED, the patient is comfortable and in no distress. His only s right thigh pain and swelling. On examination, the patient has signs and denies fever. He has no dif f culty with a straight leg raise intact extensor mechanism. He has full range of motion of his right nkle, and toes. He has 5/5 motor strength, and sensory function is intact. His distal capillary re ll is less than 2 seconds, with easily rsalis pedis and posterior tibial pulses. He has no right knee or hip ly, he has a large, super cial, mobile uid collection along his right eral thigh with several nonpainful, small, erythematous nodules. He ntial swelling of this area, with positive ballottement along the en- r and lateral thigh extending down to the knee. There is resolving along hisanteriorthightohis groin.Hehasvery scanterythematothe terior thigh, without warmth to touch or pain with palpation. He has g bites on all 4 limbs. On standing, the uid collection pools distally ty (Fig 1). The patient is noted to have a normal gait. The rest of his mination ndings are within normal limits. ious femur radiographs and MRI scans are reviewed, and an ultraso- mage of his right leg is ordered (Figs 2-5). The image reveals a large Vol. 38 No. 12 DECEMBER 2017 e45 by guest on January 10, 2018 .a .aapp ppu publ ubli blic lica ications.org/ http://pedsinreview.aappublications.org/ Looking for more pediatric review? Step up to the PREP The Curriculum review package that includes PREP Self-Assessment and Pediatrics in Review and the opportunity to earn up to 70 MOC Part 2 points. Online and Print Nonmember: $499 Member: $375 Online-Only Nonmember: $445 Member: $325 shop.aap.org/PREP AAP Journals & Periodicals EDITOR // Joseph A. Zenel, MD, FAAP DEPUTY EDITOR // Hugh D. Allen, MD, FAAP New!Find articles based on the MOCA-PEDS learning objectives by particular year. ORDER AT SHOP.AAP.ORG/JOURNALS OR CALL TOLL-FREE 866/843-2271. All pricing and specifications in this catalog are subject to change without notice. 9

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