When the Belly Looks Okay but Is Actually Not: A Case of Hepatoblastoma in a Well-Appearing Child.

Hepatoblastoma is one of the pediatric tumors with genetic and intrauterine risk factors. It is typically asymptomatic at diagnosis, at which time most patients have metastasis to the lungs and are in an advanced stage of liver disease. We report an interesting case of a 13-month-old child who presented with a one-month history of abdominal distention. A review of the systems was unremarkable but a physical examination revealed a well-appearing child with abdominal distention, normal vital signs, and an abdominal mass. Abdominal imaging revealed a well-defined heterogeneously-enhancing mass arising from the right hepatic lobe and laboratory results were consistent with a diagnosis of hepatoblastoma. The mass was resected and the patient underwent chemotherapy with continued follow-up management. We shed light on pediatric hepatoblastoma and its clinical presentation, pathology, and laboratory and imaging findings, to aid clinicians in diagnosing the condition correctly.

Idiopathic Fascicular Ventricular Tachycardia in a Pediatric Patient With Suicidal Ideation and Self-Injurious Behavior.

Idiopathic fascicular ventricular tachycardia (IFVT) is an arrhythmia that occurs in a structurally normal heart and may present with sudden onset in a healthy individual. We present the case of a 10-year-old female child, with no pertinent medical history, who complained of palpitations and shortness of breath, which was followed by suicidal ideations. On presentation to the ER, tachycardia was noted with other vital signs within normal limits. Labs were unremarkable. EKG showed wide-complex tachycardia with right bundle branch block and left superior axis, consistent with idiopathic left ventricular fascicular tachycardia. The echocardiogram showed normal cardiac structure. She was transferred to the cardiovascular care unit and intravenous verapamil was given with the resolution of symptoms and reversal of tachycardia. She remained hemodynamically stable and was subsequently discharged on oral verapamil. This case report is aimed at raising awareness of the different ways IFVT can manifest, aiding physicians to easily recognize the zebra among the horses.