Clinical Quiz Answer
What is the Diagnosis?
(a) Acute epiglottitis, retro-pharyngeal abscess & severe viral croup.
(b) Loss of cervical lordosis (probably due to para-spinal muscle spasm); increased soft tissue swelling anterior to upper cervical spines with foreign bodies (specks of fish bone) + radio-lucent patches (due to gas-forming infection).
(c) Retro-pharyngeal abscess (due to congee feeding containing fish with bones).
(a) Typhoid, T.B. Abdomen & Necrotising enterocolitis (possibility from Hirchsprung disease).
(b) Blood culture, CBC & urine analysis + cultures (ordinary + AFB); X-ray chest, Manteoux Test, Gastric aspirate for AFB and culture, Widal test.
(c) i. Patches of intestine matted together by fibrinoid exudate.
ii. Thickened bowel wall, with patchy swelling due to Peyer's patches lymphoid involvement.
iii. Enlarged lymph nodes.
(d) TB abdomen (Enteritis + peritonitis).
Additional notes: Grandmother had pulmonary TB treated for 2 months 8 years ago. She was noticed to put teaspoonful of hot congee into her mouth to ensure it was not scalding before feeding the baby. This traditional practice could have contributed to the infant's TB Abdomen.
This web site is sponsored by Johnson & Johnson (HK) Ltd.