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Child has red lump behind ear, fever. Blood work and urinalysis normal. Appenciditis suspected due to abdominal pain. Any suggestions?

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Pediatrician, Infectious Diseases
Practicing since : 2005
Answered : 1528 Questions
My ten year old daughter was admitted to Children's Hospital in Oakland, CA. I discovered a large red lump behind her ear which seems to be on the outside of the skin. She also presented with a fever for a few days, that is now gone. Blood work and urinalysis normal so far. They also suspect she may have appendicitis since she complains of pain on right side. Unfortunately I do research for Roche Labs and have access to all kinds of information. Of course, I only focus on the negative, not the postive. Any suggestions before I commit myself fro worry.
Posted Mon, 21 May 2012 in Child Health
Answered by Dr. Hema Yadav 7 hours later
Thanks for posting your query.
I would appreciate if you can describe the lump in detail or if any positive reports or photographs are available please upload the same in order to help me narrow down the possibilities.
I assume your daughter had a fever, a red lump behind the ear and pain in right side of the abdomen as the only complaints with a normal blood counts and urine analysis.
Considering this information it most probably seems to be an acute infection more commonly viral than bacterial which may have caused some lymphadenopathy and pain in abdomen.
The swelling can be anything from a minor inflammed post auricular lymph node or a folliculitis/an abscess to a more severe mastoid infection.
The pain in right lower abdomen can be due to appendicitis and if in upper abdomen it can be due to liver afflliction common in viral infections.
However since she has been examined by doctors and investigated any serious illness like a neoplasm or abscess or bacterial infection seem to be ruled out.
I understand your concern as a vigilant and educated parent but the situation doesn't seem worrisome at present.
If a case of suspected appendicitis is their most probable diagnosis then they would confirm it by other investigations like ultrasound or CT scan abdomen and grade the severity depending on which further management like antibiotics or appendicectomy can be planned.
Its a common condition in this age group and unless complicated your child will have a complete recovery soon.
Hope I have answered your query.
Above answer was peer-reviewed by
Follow-up: Child has red lump behind ear, fever. Blood work and urinalysis normal. Appenciditis suspected due to abdominal pain. Any suggestions? 11 hours later
XXXXXXX is inthe hospital and the CT could not light up the appendix area. The doctors surmise that there are other problems within the abdomenal area such as problem with small intestine. (perhaps twisted,or strangulated). In fact, the CT discovered that the intestine was in front of the appendix and that compromises the diagnosis. What other problems within this cavity can cause this. I know you cannot really answer without seeing the patient, but just taking to another professional helps. I have gone from the Medical Researcher to the blabbering mom. Meghan's lump is behind the right ear on the skin, large and red. I have no photosThaks for trying to help me.
Answered by Dr. Hema Yadav 5 hours later
Thanks for the follow up.
The problem seems to be due to a inflammation of a retrocecal appendix i.e appendix which is normally situated behind the cecum (first part of large intestine.
This can cause problems in diagnosing since it's difficult to localise such appendix on scans.
The other possibilities can be an intususeption or obstruction of intestine which can if complicated even cause strangulation of bowel.In such case the symptoms also include constipation, or blood in stools, colicky pain, distension of abdomen,vomiting or nausea, fever etc.However in any case if antibiotics and antiinflammatory drugs do not cause relief or obstruction is confirmed or highly suspected then the best next step is an exploratory laparoscopy or laparotomy.
If symptoms subside and there is less suspicion of complications depending on condition of patient then conservative management might be preferred.
The lump most probably seems to be a local infection like folliculitis or an inflammed lymph node which should subside with the present antibiotic treatment within a week.
Hope that answers your query.
Wishinh XXXXXXX a speedy recovery.
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