ANSWERAt this time, our group entertained the following possibilities
2. interstitial lung disease
3. cardiac pathology
5. celiac disease
6. gastro-esophageal reflux
EXAMINATIONHe was afebrile, pale and thin. His O2 saturation was 96% in room air but dropped quickly with activity. Breath sounds were decreased in the right base with crackles heard in both bases. No wheeze was audible. His second heart sound was normal. There was slight tenderness in his epigastrium and right upper quadrant. There was marked clubbing of his fingers and toes.
IN SUMMARY, he is a 12 year old boy with acute pneumonia who is clubbed with a history of chronic respiratory symptoms and moderately recent onset of intermittent abdominal symptoms.
IS YOUR DIFFERENTIAL DIAGNOSIS AT THE MOMENT?
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