Polly Pocket – Pediatrics

CC – Shortness of breath and back pain

Diagnosis – Lymphoma, Myocarditis, Pericarditis, Tuberculosis, Pneumonia/bacterial(NOS),

heartfailure/CHF

Tests- Chest X-ray PA and Lateral, Chest CT, Echocardiogram-transthoracic (TTE), 12 lead

echocardiogram (ECG), Arterial blood gases (ABG), CMP/Chem13, Lymph node biopsy, Tuberculin skin

test

Problem Statement:

( Demographic description – chief complaint – Hx and PE key findings – risk factors )

Polly Pocket is a 18yo girl brought in by her mother with complaint of shortness of breath with

accompanied back pain. She states that she has respiratory distress even at rest that has been increasing

in severity over the last 2 hours and had insidiously started over 2 weeks, she reports 10/10 sharp deep

back pain in midthoracic region that also started 2 weeks ago, along with this she has lost 10 pounds

over the past month. PE shows L-supraclavicular lymph node 2cm enlarged with fullness above Lclavicle, Trachea seems deviated, chest inspection shows diminished respiratory rise on left side – lung

auscultation shows absent breath sounds in LLL and diminished sounds in LUL. PMI is displaced towards

the sternum and CVA tenderness is absent. PMH and FH are unremarkable.

CC: Polly Pocket is a 18yo girl brought in by her mother with complaint of shortness of breath with

accompanied back pain

HPI: She states that she has respiratory distress even at rest that has been increasing in severity over

the last 2 hours and had insidiously started over 2 weeks, she reports 10/10 sharp deep back pain in

midthoracic region that also started 2 weeks ago, along with this she has lost 10 pounds over the past

month with night sweats.

Meds: Prednisone for suspected Fibromyalgia 10 days ago. Acetaminophen and ibuprofen for pain

PMH: noncontributory

FH: unremarkable

SH: Unremarkable

ROS: Only positive findings are seen in HPI

Physical Exam:

VS: Pulse – 94; BP – 120/80 RR – 34; T – 98.6F; SpO2 – 94%

Neck: Suspicious for tracheal deviation

Chest: Diminished respiratory rise on left (vs. right) on inspiration, auscultation shows no breath sounds

in Left lower lung and diminished breath sounds in left upper lung.

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