Ronald Swanger, MD

For 3 months, a 9-year-old boy had swelling of the left upper arm. An MRI scan obtained at another facility 1 week after onset showed extensive edema of the soft tissue at the midhumeral level. Laboratory results, including complete blood cell (CBC) count and Lyme titer, were normal.

An 11-year-old girl was brought to the emergency department (ED) after 3 days of intermittent, dull, nonradiating left lower abdominal pain. She also had 3 episodes of nonbloody, nonbilious emesis in the 2 days before presentation. Three days earlier, the patient had been vaccinated against influenza and varicella by her pediatrician.

In the ED, the patient was afebrile. The pain remained localized to the left lower quadrant; it increased with palpation and decreased when the child lay still. A transabdominal pelvic ultrasonogram was normal: specifically it showed no ovarian torsion.