Vera De Matos, MD; Pierre Russo, MD; Holly Hedrick, MD; David A. Piccoli, MD; Petar Mamula, MDSeries Editors: David A. Piccoli, MD; Petar Mamula, MD


August 03, 2005

Case Presentation

A 2-year-old girl with a history of ascites was referred for evaluation. She was born at full term, and her growth and development were normal. Her past medical history was unremarkable until she presented to her pediatrician with abdominal distension and mild constipation at the age of 15 months. No other symptoms were present at that time. There was no family history of gastrointestinal disorders, liver or pancreas disease, or cancer. There was no history of allergy to medication and her immunizations were up to date.

On admission she appeared healthy. Her vital signs were normal and she was afebrile. Weight and height were in the 50th percentile. She had no adenopathy, scleral icterus, or jaundice. Chest and heart exams were normal. The abdomen was distended, soft and nontender, with no masses palpable. A wave was felt but there was no shifting dullness. The spleen and liver were not enlarged. Neurologic exam was normal. The remainder of the physical exam was normal.

The following laboratory tests were ordered and were normal or negative: white blood cell count (WBC) with differential; chemistry panel including serum albumin and total protein; serum lactate dehydrogenase; uric acid; liver enzyme levels, including alkaline phosphatase and gamma glutamyltransferase; prothrombin time and international normalized ratio; pancreatic enzymes; celiac panel; thyroid function tests; and urine analysis. A tuberculin test was negative and a sweat test was also negative.

An abdominal ultrasound (US) and computed tomography (CT) scan were obtained (Figures 1, 2).

Abdominal US.

Abdominal CT scan.

How do you interpret the findings on abdominal US and CT scan?

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