Stories about: Challenging Cases

Challenging case: Enterovirus

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On Oct. 3, 2014, Elisa Holt was nursing her six-month-old son Noah when she realized he wasn’t moving his feet, legs or toes. Panicked, she called her pediatrician at Garden City Pediatrics and was directed to Beverly Hospital.

“We are so thankful for the emergency room doctor [Dr. Munirah Qualls] who told us, ‘I don’t know. I’m going to send you to Boston Children’s Hospital.’”

Within 15 minutes, an ambulance arrived to rush Noah to Boston Children’s where the emergency department was on high alert for EV D-68.

A bedside spinal tap and initial lab results narrowed Noah’s diagnosis to either Guillain Barre Syndrome or a type of myelitis possibly caused by EV-D68. Both conditions can be treated with immunotherapy, so Noah’s doctors moved forward with treatment.

Then an MRI confirmed Acute Flaccid Myelitis (AFM), a disorder caused by inflammation of the spinal cord. “We don’t know if EV D68 is the cause of AFM. There’s epidemiologic evidence that suggests it is, but we don’t have hard data to suggest that’s the case,” explains Mark Gorman, MD, from the Boston Children’s Hospital Department of Neurology.

The unproven link between enterovirus and AFM is not the only mystery associated with the virus.

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Challenging Cases: Minimally invasive renal preservation surgery

robotic surgery minimally invasive urology nephrology

Robotic assisted laparoscopic partial nephrectomy can be safely and effectively performed in pediatric patients for renal tumors while preserving renal function. Classically, cases such as the two described below have been managed with an open, invasive approach or by radical nephrectomy. These two cases, cared for in collaboration with specialists from Dana-Farber/Boston Children’s Cancer and Blood Disorders Center, demonstrate the effectiveness of renal preservation using robotic assisted laparoscopic surgery applied for renal masses in two different pediatric patients. …Read More

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Challenging Case: A child with a Monteggia fracture

Monteggia fracture X-ray

A six-year-old boy presented to the Orthopedic Center at Boston Children’s Hospital in July 2014 having sustained an injury during a fall that spring. The treating physician did not initially recognize the injury as a Monteggia fracture, a fairly uncommon and often unrecognized injury. …Read More

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Challenging Case: Heart failure or Vein of Galen?

Vein of Galen preoperative imageryThe patient is a four-month-old boy from Haiti with a history of low weight gain, cachexia, congestive heart failure and pulmonary hypertension, but with no discernable cause. After first presenting to a hospital in Haiti, he was treated with oxygen concentrators and sildenafil to maintain his oxygen saturation levels, but could not gain weight. …Read More

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