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Special Feature
July 2007

Picture of the Month—Quiz Case

Author Affiliations
 

ALBERT CYANMDSAMIR S.SHAHMD

Arch Pediatr Adolesc Med. 2007;161(7):711. doi:10.1001/archpedi.161.7.711

A term baby was born by spontaneous vaginal delivery to a gravida 5, para 5 mother. His Apgar score was 7 after 1 minute. At 5 minutes, the score was 8 because of the presence of acrocyanosis and low heart rate. He was appropriate for gestational age with a birth weight of 3417 g, length of 51.7 cm, and head circumference of 35.5 cm. On examination, there was a bifid thumb with duplication of the distal phalanx on the right hand (Figure 1). On auscultation, an ejection systolic murmur grade 2/6 on the left sternal border was heard. Electrocardiography showed bradycardia with a heart rate of 93 beats/min. Echocardiography revealed a secundum atrial septal defect measuring 1.33 cm (Figure 2). There was no family history of any limb or heart defects.

Figure 1.
Bifid thumb on right hand.

Bifid thumb on right hand.

Figure 2.
Echocardiogram (subcostal view) showing the atrial septal defect. HR indicates heart rate.

Echocardiogram (subcostal view) showing the atrial septal defect. HR indicates heart rate.

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