This week’s free board review question…
A 7-week-old female infant presents with wheezing, coughing, and 2 episodes of nonbilious emesis.
Examination reveals her vital signs as temperature (rectal): 98.96 °F (37.2 °C), pulse 168 beats/minute, respiratory rate 70 breaths/minute, blood pressure 126/86 mm Hg, and oxygen saturation 96% (breathing room air).
The infant is fussy, though consolable, with moderate respiratory distress. She is nontoxic in appearance. The anterior fontanelle is soft and flat. The pupils are equal and reactive, and the mucous membranes were moist. Her neck is supple.
The lungs have diffuse wheezes and bilateral crackles with intercostal retractions. Heart sounds are difficult to auscultate due to the noisy breathing, but no obvious loud pathologic murmur is heard. The femoral pulses are difficult to palpate. Blood pressure is taken at the 4 extremities: 126/86 mm Hg (left arm), 132/92 mm Hg (right arm), 69/41 mm Hg (left leg), and 63/59 mm Hg (right leg).
The abdomen is soft and nontender with active bowel sounds. The liver edge is palpable 3 to 4 cm below the right costal margin. Capillary refill time in the extremities is 3 seconds.
The patient is placed on supplemental oxygen. Chest x-ray is obtained (see Figure).
Based on the above information, what is the most likely diagnosis?
transposition of the great vessels
patent ductus arteriosus (PDA)
hypoplastic left ventricle syndrome
coarctation of the aorta (COA)
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