RT Journal
A1 Perkins R, Reddy J, Lal R
T1 IMage of the month—quiz case
JF Archives of Surgery
JO Archives of Surgery
YR 2010
FD March 1
VO 145
IS 3
SP 307
OP 307
DO 10.1001/archsurg.2010.13-a
UL http://dx.doi.org/10.1001/archsurg.2010.13-a
AB 
On physical examination, the child's nutritional status was visibly impaired, with evidence of growth retardation for his stated age. On abdominal examination, the patient was visibly and symmetrically distended. Bowel sounds were not audible. His abdominal girth was measured to be 70 cm. The abdomen was soft and nontender to palpation. There was no evidence of organomegaly, but liver and spleen contours were difficult to appreciate. A fluid thrill was present, but without shifting dullness. A distinct band of resonance was present in the epigastrium and left upper quadrant. Results of cardiovascular, pulmonary, and neurovascular examination were unremarkable.