A 5-Month-Old Boy Rushed to the Hospital in Shock

Jaime Shalkow, MD; Mayela E. García

Disclosures

June 18, 2018

Editor's Note:
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Background

The parents of a 5-month-old boy rush him to the emergency department (ED) in the middle of the night owing to recent lethargy and severe abdominal distention. Prenatal ultrasonography findings were normal; he was born at 36 weeks' gestation via uncomplicated vaginal delivery, weighed 5.73 lb, and was discharged home with his parents.

During the infant's first 3 months of life, he fed and grew properly, with normal development. Six weeks before the current episode, he developed sudden abdominal distention and decreased oral intake, with occasional postprandial vomiting of gastric contents, with no other major symptoms. Plain radiography revealed a large opacity on the right side of the abdomen (Figure 1). Doppler ultrasonography revealed a large, nonvascularized cystic mass on the undersurface of the liver (Figure 2). CT and MRI confirmed the presence of a large, septated, cystic mass under the liver, displacing the ascending colon downward (Figures 3-5).

Figure 1.

Figure 2.

Figure 3.

Figure 4.

Figure 5.

The patient's serum alpha-fetoprotein (AFP) level was 900 ng/mL. The rest of the blood work, including liver function, was normal. At the initial institution, abdominal lymphatic malformation was diagnosed, and the patient underwent fluoroscopy-guided percutaneous sclerosis of the lesion with doxycycline (Figure 6).

Staples were used to fix the cyst to the abdominal wall in order to avoid drug leakage into the peritoneum. The patient was discharged home the next morning in good condition. After 3 weeks, abdominal distention and hyporexia persisted, and he was started on sildenafil (0.5 mg/kg/day) in an attempt to accelerate the clinical response. Two days later, the boy suddenly became unresponsive, flaccid, and pale, which is when his parents rushed him to the ED.

Figure 6.

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