This section of Pediatrics in Review reminds clinicians of those conditions that can present in a misleading fashion and require suspicion for early diagnosis. Emphasis has been placed on conditions in which early diagnosis is important and that the general pediatrician might be expected to encounter, at least once in a while. The reader is encouraged to write possible diagnoses for each case before turning to the discussion, which is on the following page.

We invite readers to contribute case presentations and discussions.

Case 1 Presentation

The parents of a 6-year-old boy would like your opinion regarding a tonsillectomy and adenoidectomy for their son. His speech development has been delayed, and even now, despite 2 years of therapy, he is difficult to understand. The child had experienced recurrent ear infections for which pressure equalization tubes were placed 4 years ago. Physical examination reveals bilateral serous otitis media and a bifid uvula. The tonsils appear normal for his age. His speech has a hypernasal quality. An audiologic evaluation reveals bilateral conductive hearing loss. You see a pattern that suggests an underlying condition with important therapeutic implications.

Case 2 Presentation

A 6-week-old infant is brought to the emergency room because of bleeding from the umbilicus for 8 hours.

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