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April 1992

Radiological Case of the Month

Am J Dis Child. 1992;146(4):423-424. doi:10.1001/archpedi.1992.02160160043010

A full-term, spontaneously delivered female newborn was assessed for existence of a systolic heart murmur. A chest roentgenogram at age 4 days was normal. At age 2 weeks, she became more tachypneic and fed more slowly. Examination showed an afebrile, well-nourished infant with a respiratory rate of 90 breaths per minute. There were subcostal retractions and slight respiratory crepitation on auscultation. A heart murmur was considered insignificant. The liver was massively enlarged, extending 6 to 7 cm below the costal margin at the midclavicular line, with a smooth border and a firm consistency. Another chest roentgenogram (Fig 1) showed coarse mottling and nodular opacities in both lungs. Sepsis workup, including a lumbar puncture, was performed. Results of biochemical and microscopic evaluation of cerebrospinal fluid were normal. The infant began receiving intravenous cefotaxime, cloxacillin, and amikacin. One day later, the left big toe of the infant became darkened, indicating the beginning