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Resident PGY 2
Henry Ford Wyandotte
Our case presents a rare diagnosis that will most likely never be encountered by the community emergency medicine physician. It demonstrates how a thorough physical exam and appropriate imaging can differentiate benign vs. serious processes in a common complaint, and lead to further work up and diagnosis of a serious life-threatening etiology. Alveolar Rhabdomyosarcoma is a rare soft tissue tumor seen in children and adolescents. In this case report, we discuss how the common emergency department chief complaint of abdominal pain lead to the uncommon diagnosis of a rare tumor. This Emergency Department workup and appropriate imaging allowed for identification and necessary transfer to a specialty center, which led to definitive diagnosis and prompt treatment of this rare condition. In our case a 13-year-old male with no past medical history presented to the emergency department with his parents for evaluation of three days of abdominal pain. Physical exam demonstrated an uncomfortable appearing male with right upper quadrant and right lower quadrant tenderness with involuntary guarding. The patient was found to have a leukocytosis and in the setting of involuntary guarding, a CT scan of the abdomen and pelvis was obtained, and demonstrated a large mass in the right upper abdomen. The patient was transferred to a nearby pediatric hospital, and was evaluated by pediatric surgery and hematology/oncology and was diagnosed with an alveolar rhabdomyosarcoma. Currently, the patient is continuing treatment with chemotherapy. Alveolar rhabdomyosarcoma represents less than 1% of all childhood malignancies. They have an annual incident rate of less than 1 per million children. The most common locations for this tumor are the limbs, spinal cord, and pelvic region, followed by the urogenital area. Other not so frequent locations include the skin and abdomen (such as in our case) In this case, the patient had a common complaint most emergency physicians will see daily in their pediatric patient population, however, the patient had persistent involuntary guarding which is a red flag physical exam finding. Red flag signs, symptoms and physical exam findings, can distinguish benign pediatric abdominal pain from serious etiology. In this case, the work up led to discovery of a rare presentation of a life-threatening tumor.
Jump, Zachary; Zygowiec, Jonathan; Correa, Kelly; and Engelbrecht, Marc, "Alveolar Rhabdomyosarcoma" (2019). Case Reports. 128.