Zitelli and Davis’ Atlas of Pediatric Physical Diagnosis

1032 Pages·2017·152.07 MB·English

by  Basil J. Zitelli

ZITELLI AND DAVIS’
A T L A S O F
PEDIATRIC
PHYSICAL DIAGNOSIS
ZITELLI AND DAVIS’
A T L A S O F
PEDIATRIC PHYSICAL
DIAGNOSIS
SEVENTH EDITION
BASIL J. ZITELLI, MD
Professor of Pediatrics
University of Pittsburgh School of Medicine
Director
The Paul C. Gaffney Diagnostic Referral Service
Children’s Hospital of Pittsburgh of UPMC
Pittsburgh, Pennsylvania
SARA C. McINTIRE, MD
Professor of Pediatrics
University of Pittsburgh School of Medicine
Advisory Dean
Office of Student Affairs
Children’s Hospital of Pittsburgh of UPMC
Pittsburgh, Pennsylvania
ANDREW J. NOWALK, MD, PhD
Assistant Professor of Pediatrics
University of Pittsburgh School of Medicine
Pediatric Infectious Disease
Children’s Hospital of Pittsburgh of UPMC
Pittsburgh, Pennsylvania
IN MEMORIUM
Holly W. Davis, MD ambulatory chief resident. In 1978 she became the medical director
August 23, 1945–September 6, 2013 of the Emergency Department. Her focus on children led to an
invitation to “Mr. Rogers’ Neighborhood” television program to
We miss Holly Davis. Holly W. Davis, explain to children in the audience what to expect and how they
MD, an original co-editor and con- would be cared for in the Emergency Department. She reassured
tributor to the Atlas, passed away in children and parents that we “had a lot of different ways in which
2013 after battling cancer. Holly we help children get better.” She spearheaded the construction of a
helped to develop the concept of the new Emergency Department with innovative ideas emulated by
Atlas and worked tirelessly with con- many institutions around the country. In 1999 Holly became co-
tributors over 6 editions to shape the director of the Child Advocacy Center until her retirement in 2005.
style, provide clinical images and She became well-known for her skill in evaluation and detection of
assure the quality of the textbook. abuse and neglect in children. She was a fierce advocate for these
Holly was a consummate clini- children.
cian–educator. She was widely respected not only for her diagnostic Holly Davis was an accomplished pediatrician, respected clini-
and clinical acumen, but also for her boundless energy, enthusiasm cian, teacher, mentor, colleague and friend. But even more, Holly
and focus on the child and family. loved teaching, loved children and loved life. We were fortunate
Holly attended Duke University for undergraduate school and to know Holly, work with her and honored to call her friend. We
graduated from its medical school in 1971. She completed pediatric miss her.
residency at Children’s Hospital of Pittsburgh and went on to become
v
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ZITELLI AND DAVIS’ ATLAS OF PEDIATRIC PHYSICAL ISBN: 978-0-323-39303-4
DIAGNOSIS, SEVENTH EDITION
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CONTRIBUTORS
Wael Abdel Kawy Abdalla, MD, MSc Elaine Cassidy, MD
Assistant Professor Assistant Professor of Pediatrics
Department of Radiology Division of Pediatric Rheumatology
Children’s Hospital of Pittsburgh of UPMC Children’s Hospital of Pittsburgh of UPMC
Pittsburgh, Pennsylvania Pittsburgh, Pennsylvania
Vivek Allada, MD Diego Chaves-Gnecco, MD, MPH, FAAP
Associate Professor of Pediatrics Assistant Professor of Pediatrics
University of Pittsburgh School of Medicine University of Pittsburgh School of Medicine
Clinical Director SALUD PARA NINOS Program Director and Founder
Pediatric Cardiology, Heart Center Developmental-Behavioral Pediatrics
Children’s Hospital of Pittsburgh of UPMC Children’s Hospital of Pittsburgh of UPMC
Pittsburgh, Pennsylvania Pittsburgh, Pennsylvania
Georgianne Arnold, MD Wassim Chemaitilly, MD
Professor of Pediatrics Assistant Professor of Pediatrics
University of Pittsburgh School of Medicine Division Director
Children’s Hospital of Pittsburgh of UPMC Pediatric Endocrinology
Pittsburgh, Pennsylvania St. Jude Children’s Research Hospital
Memphis, Tennessee
Arcangela Lattari Balest, MD
Assistant Professor of Pediatrics Kenneth P. Cheng, MD
Division of Newborn Medicine Children’s Hospital of Pittsburgh of UPMC
Children’s Hospital of Pittsburgh of UPMC Wexford, Pennsylvania
Pittsburgh, Pennsylvania
David H. Chi, MD
Heather Baumhardt, DDS Assistant Professor
Clinical Assistant Professor University of Pittsburgh School of Medicine
University of Pittsburgh School of Dental Medicine Director
Pediatric Dentistry Hearing Center
Children’s Hospital of Pittsburgh of UPMC Division of Pediatric Otolaryngology
Pittsburgh, Pennsylvania Children’s Hospital of Pittsburgh of UPMC
Pittsburgh, Pennsylvania
Lee B. Beerman, MD
Professor of Pediatrics Hey Jin Chong, MD, PhD
University of Pittsburgh School of Medicine Assistant Professor of Pediatrics
Division of Pediatric Cardiology Division of Pulmonary Medicine, Allergy & Immunology
Children’s Hospital of Pittsburgh of UPMC Children’s Hospital of Pittsburgh of UPMC
Pittsburgh, Pennsylvania Pittsburgh, Pennsylvania
Debra L. Bogen, MD James D. Cooper, MD
Associate Professor of Pediatrics and Psychiatry Assistant Professor of Pediatrics
University of Pittsburgh School of Medicine University of Pittsburgh School of Medicine
Division of General Academic Pediatrics Pediatric Hematology/Oncology/BMT
Children’s Hospital of Pittsburgh of UPMC Children’s Hospital of Pittsburgh of UPMC
Pittsburgh, Pennsylvania Pittsburgh, Pennsylvania
Mary M. Carrasco, MD, MPH Alene D’Alesio, DMD
Associate Clinical Professor of Pediatrics Clinical Assistant Professor
University of Pittsburgh School of Medicine Pediatric Dentistry
Director Children’s Hospital of Pittsburgh of UPMC
International and Community Health Pittsburgh, Pennsylvania
Mercy Children’s Medical Center Pediatrics
Pittsburgh, Pennsylvania
vii
viii Contributors
Vincent F. Deeney, MD Dena Hofkosh, MD
Associate Professor Professor of Pediatrics
Department of Orthopaedics University of Pittsburgh School of Medicine
Residency Program Director Developmental-Behavioral Pediatrics
Orthopaedic Surgery Children’s Hospital of Pittsburgh of UPMC
University of Pittsburgh Medical Center Pittsburgh, Pennsylvania
Pittsburgh, Pennsylvania
Emily Joyce, MD
Demetrius Ellis, MD Fellow in Pediatric Nephrology
Professor of Pediatrics and Nephrology Department of Pediatrics
University of Pittsburgh School of Medicine University of Pittsburgh School of Medicine
Children’s Hospital of Pittsburgh of UPMC Pittsburgh, Pennsylvania
Pittsburgh, Pennsylvania
Aviva Katz, MD, MA, FACS, FAAP
Oscar Escobar, MD Associate Professor of Surgery
Associate Professor of Pediatrics University of Pittsburgh School of Medicine
Division of Endocrinology Pittsburgh, Pennsylvania
University of Pittsburgh School of Medicine
Children’s Hospital of Pittsburgh of UPMC Jacqueline Kreutzer, MD, FACC, FSCAI
Pittsburgh, Pennsylvania Associate Professor of Pediatrics
University of Pittsburgh School of Medicine
Heidi M. Feldman, MD, PhD Department of Pediatrics
Ballinger-Swindells Professor Director
Department of Pediatrics Cardiac Catheterization Laboratory
Stanford University School of Medicine Pediatric Cardiology
Stanford, California Children’s Hospital of Pittsburgh of UPMC
Pittsburgh, Pennsylvania
Jonathan D. Finder, MD
Professor of Pediatrics Allyson Larkin, MD
University of Pittsburgh School of Medicine Assistant Professor of Pediatrics
Clinical Director Division of Allergy & Immunology
Pediatric Pulmonary Medicine Children’s Hospital of Pittsburgh of UPMC
Children’s Hospital of Pittsburgh of UPMC Pittsburgh, Pennsylvania
Pittsburgh, Pennsylvania
Joseph E. Losee, MD, FACS, FAAP
Robin P. Gehris, MD Professor of Surgery and Pediatrics
Chief University of Pittsburgh School of Medicine
Pediatric Dermatologic Surgery Chief
Department of Dermatology Division of Pediatric Plastic Surgery
Children’s Hospital of Pittsburgh of UPMC Children’s Hospital of Pittsburgh of UPMC
Pittsburgh, Pennsylvania Pittsburgh, Pennsylvania
Jesse A. Goldstein, MD Suneeta Madan-Khetarpal, MD
Assistant Professor Associate Professor of Pediatrics
University of Pittsburgh School of Medicine Division of Medical Genetics
University of Pittsburgh Medical Center Department of Pediatrics
Pediatric Plastic and Reconstructive Surgery Children’s Hospital of Pittsburgh of UPMC
Children’s Hospital of Pittsburgh of UPMC Pittsburgh, Pennsylvania
Pittsburgh, Pennsylvania
Brian Martin, DMD
Todd Green, MD Clinical Assistant Professor
Assistant Professor of Pediatrics University of Pittsburgh School of Dental Medicine
University of Pittsburgh School of Medicine Chief
Allergy and Immunology Division of Pediatric Dentistry
Children’s Hospital of Pittsburgh of UPMC Children’s Hospital of Pittsburgh of UPMC
Pittsburgh, Pennsylvania Pittsburgh, Pennsylvania
Lorelei J. Grunwaldt, MD Andrew A. McCormick, MD
Director Vascular Anomalies Center Assistant Professor of Pediatrics
Director Brachial Plexus Clinic Department of Pediatrics
Assistant Professor of Surgery Children’s Hospital of Pittsburgh of UPMC
Children’s Hospital of Pittsburgh of UPMC Pittsburgh, Pennsylvania
Pittsburgh, Pennsylvania
Contributors ix
Sara C. McIntire, MD Jeffrey A. Rudolph, MD
Professor of Pediatrics Assistant Professor of Pediatrics
University of Pittsburgh School of Medicine University of Pittsburgh School of Medicine
Advisory Dean Division of Pediatric Gastroenterology
Office of Student Affairs Children’s Hospital of Pittsburgh of UPMC
Children’s Hospital of Pittsburgh of UPMC Pittsburgh, Pennsylvania
Pittsburgh, Pennsylvania
Heidi A. Stephany, MD
Marian G. Michaels, MD, MPH Assistant Professor
Professor of Pediatrics and Surgery Pediatric Urology
University of Pittsburgh School of Medicine Children’s Hospital of Pittsburgh of UPMC
Pediatric Infectious Diseases Pittsburgh, Pennsylvania
University of Pittsburgh School of Medicine
Pittsburgh, Pennsylvania Gina S. Sucato, MD, MPH
Director, Adolescent Center
Yosuke Miyashita, MD, MPH Kaiser Permanente Washington Health Research Institute
Assistant Professor of Pediatrics Clinical Associate Professor of Pediatrics
Department of Pediatrics University of Washington
University of Pittsburgh School of Medicine
Pittsburgh, Pennsylvania Sylvia Szentpetery, MD
Pediatric Pulmonology Fellow
Pamela J. Murray, MD, MPH Children’s Hospital of Pittsburgh of UPMC
Adolescent Medicine Pittsburgh, Pennsylvania
Section Chief Professor of Pediatrics
West Virginia University School of Medicine Sameh Tadros, MD, MSc
Morgantown, West Virginia Clinical Assistant Professor
University of Pittsburgh School of Medicine
Srikala Narayanan, MD Department of Radiology
Clinical Instructor Children’s Hospital of Pittsburgh of UPMC
Department of Radiology Pittsburgh, Pennsylvania
Children’s Hospital of Pittsburgh of UPMC
Pittsburgh, Pennsylvania Jean M. Tersak, MD
Assistant Professor of Pediatrics
Andrew J. Nowalk, MD University of Pittsburgh School of Medicine
Assistant Professor of Pediatrics Division of Pediatric Hematology/Oncology and Blood and
University of Pittsburgh School of Medicine Marrow Transplantation
Pediatric Infectious Disease Children’s Hospital of Pittsburgh of UPMC
Children’s Hospital of Pittsburgh of UPMC Pittsburgh, Pennsylvania
Pittsburgh, Pennsylvania
Kathryn Torok, MD
Michael C. Ost, MD Assistant Professor Pediatrics
Chief Division of Rheumatology
Division of Pediatric Urology UPMC & University of Pittsburgh Scleroderma Center
Vice-Chairman Children’s Hospital of Pittsburgh of UPMC
Department of Urology Pittsburgh, Pennsylvania
Children’s Hospital of Pittsburgh of UPMC
Associate Professor of Urology Rajiv Varma, MD
University of Pittsburgh School of Medicine Clinical Associate Professor
Pittsburgh, Pennsylvania Clinical Director
Division of Pediatric Neurology
Ward Richardson, MD University of Pittsburgh School of Medicine
Assistant Professor of Surgery Children’s Hospital of Pittsburgh of UPMC
Division of Pediatric and General Thoracic Surgery Pittsburgh, Pennsylvania
University of Pittsburgh School of Medicine
Children’s Hospital of Pittsburgh of UPMC Pushpa Viswanathan, MD
Pittsburgh, Pennsylvania Assistant Professor
Division of Pediatric Endocrinology
Melissa M. Riley, MD University of Pittsburgh School of Medicine
Assistant Professor of Pediatrics Children’s Hospital of Pittsburgh of UPMC
University of Pittsburgh School of Medicine Pittsburgh, Pennsylvania
Pittsburgh, Pennsylvania
Margalit Rosenkranz, MD
Assistant Professor
University of Pittsburgh School of Medicine
Division of Pediatric Rheumatology
Children’s Hospital of Pittsburgh of UPMC
Pittsburgh, Pennsylvania
x Contributors
Daniel J. Weiner, MD Katelyn Woods, DMD
Associate Professor of Pediatrics Pediatric Dental Services
Department of Pediatrics Children’s Hospital of Pittsburgh of UPMC
University of Pittsburgh School of Medicine Pittsburgh, Pennsylvania
Co-Director
Antonio J. and Janet Palumbo Cystic Fibrosis Center Robert F. Yellon, MD
Medical Director Professor of Otolaryngology
Pulmonary Function Laboratory University of Pittsburgh School of Medicine
Children’s Hospital of Pittsburgh of UPMC Co-Director
Pittsburgh, Pennsylvania Division of Pediatric Otolaryngology
Director
John V. Williams, MD ENT Clinical Services
Chief Children’s Hospital of Pittsburgh of UPMC
Division of Pediatric Infectious Diseases Pittsburgh, Pennsylvania
Professor of Pediatrics
University of Pittsburgh School of Medicine Fateema Turay Rose, MD
Pittsburgh, Pennsylvania Fellow, Pediatric Gastroenterology
University of Pittsburgh School of Medicine Member
Shelley D. Williams, MD Division of Gastroenterology
Associate Professor of Pediatrics and Neurology Children’s Hospital of Pittsburgh of UPMC
University of Pittsburgh School of Medicine Pittsburgh, Pennsylvania
Division of Child Neurology
Children’s Hospital of Pittsburgh of UPMC Basil J. Zitelli, MD
Pittsburgh, Pennsylvania Professor of Pediatrics
University of Pittsburgh School of Medicine
Selma Feldman Witchel, MD Director
Associate Professor of Pediatrics The Paul C. Gaffney Diagnostic Referral Service
Pediatric Endocrinology, Diabetes and Metabolism Children’s Hospital of Pittsburgh of UPMC
University of Pittsburgh School of Medicine Pittsburgh, Pennsylvania
Children’s Hospital of Pittsburgh of UPMC
Pittsburgh, Pennsylvania
Jennifer E. Wolford, DO, MPH
Assistant Professor of Pediatrics
University of Pittsburgh School of Medicine
Pittsburgh, Pennsylvania
To our parents, who were our first teachers:
Hannah L. Zitelli and Patsy A. Zitelli
Thomas P. Nowalk and Lourdes W. Nowalk
George M. McIntire and Charlotte M. McIntire
To my wife, Suzanne, and my children,
Matthew, Daniel, Benjamin, and Anne Zitelli
To my wife, Amy Brinkos, and my children,
James, Max, and Peter Nowalk
To my brother, John, and my children,
Frances and Madeline Marcelle
To those exceptional teachers we have had, whose
dedication, enthusiasm, and creativity helped make the
acquisition, application, and sharing of knowledge more
fun than hard work and who inspired us not only to
perform to the best of our ability but also to
become teachers as well as physicians:
Henry Furrie, Paul C. Gaffney, MD, William H. Zinkham, MD,
J.R. Zuberbuhler, MD, Crystie Halsted, MD,
Ronald Lemire, MD, J. Carlton Gartner Jr., MD,
William I. Cohen, MD
To our residents and students, whose eagerness to learn
and to put their knowledge to use keeps us learning
actively and makes teaching so rewarding
FOREWORD
There aren’t many texts that stand the test of time, but the book you It is often said that the art of the physical exam is atrophying from
hold in your hand, or – more likely, given its considerable heft – on disuse, as are medical libraries of physical books, both victims of the
your lap or desk, has been proving its worth to students of pediatrics digital age. Yet, the physical exam (along with the medical history)
at all stages of their training and careers for 30 years and 7 editions. remains essential to the complete physician, and this book is a price-
Zitelli and Davis (now ably edited by Drs Zitelli, McIntire, and less reminder of the value of an actual book, with pages, stunning
Nowalk – all widely admired clinicians and diagnosticians) is revered pictures, chapters, and indices.
for its breadth and depth, and especially for its extensive use of Enjoy this book, and learn from it, and keep going back to refer
superb visual material, including striking photographs, radiographs, to it, as generations of clinicians before you have done with previous
and data graphs. editions.
David M. Orenstein, MD, MA
Antonio J. and Janet Palumbo Professor of Cystic Fibrosis
Director Emeritus, Antonio J. and Janet Palumbo Cystic
Fibrosis Center
Chair, Ethics Committee
Children’s Hospital of Pittsburgh of UPMC
Professor of Pediatrics
School of Medicine
Professor of Health and Physical Activity
School of Education
University of Pittsburgh
xii