Twelve cases of liver abscess in children and adolescents presenting at Children's Hospital at Los Angeles from 1974 to 1983 were reviewed. Most occurred in children younger than 5 years of age. The time from onset of symptoms to presentation did not differ over the 10-year period examined. However, diagnosis was made more rapidly in the latter half of the decade due to the development of advanced noninvasive imaging techniques and serologic methods. A constellation of fever, abdominal pain (whether or not localized in the right upper abdomen), vomiting or anorexia, hepatomegaly, elevated white blood cell count and sedimentation rate, and an unexplained anemia should prompt the clinician to include occult liver abscess in the differential diagnosis and proceed to early use of ultrasound or isotopic liver-spleen scan. History of travel or immigration or exposure to food handlers harboring the infection is important to differentiate amebic abscess from bacterial abscess. This suspicion may greatly alter the course of treatment.

BACKGROUND: To evaluate the utility of echocardiogram (ECHO) in detection and treatment of patent ductus arteriosus (PDA) and hemodynamically significant PDA (hsPDA) in preterm neonates. METHODS: This was a retrospective case-control study of all preterm infants born or admitted to the level III Neonatal Intensive Care Unit in McMaster Children’s Hospital from January 2009 to January 2013. These cases were further classified into the following sub-groups: group A) hsPDA confirmed on ECHO; and the control, group B) PDA (but not hemodynamically significant) confirmed on ECHO. Patients without an ECHO were excluded from all analyses. The primary outcome was incidence of treatment for PDA. RESULTS: PDA treatment was administered in 83.3% and 11.2% of patients in groups A and B respectively (P < 0.05). Among patients with a hsPDA within group A, 17% did not receive treatment, while 11% of patients with non-hemodynamically significant PDA received treatment for the PDA. Within the cohort of patients who received treatment for a hsPDA, gestational age below 35 weeks as well as murmurs heard on auscultation were both found to be predictors of treatment. CONCLUSION: While the ECHO remains the gold standard for detecting pathological PDA, there is evidence that other traditional clinical measures continue to guide clinical practice and treatment decisions. Further research is required to gain an understanding of how clinical measures and ECHO may be used in conjunction to optimize resource utilization.