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July 1995

Radiological Case of the Month

Author Affiliations

From the Departments of Pediatrics (Drs Wilczewski, de Alarcon, and Alford), Radiology (Drs Hinn and Alford), and Hematology-Oncology (Dr de Alarcon), University of Virginia Health Sciences Center, Children's Medical Center, Charlottesville.

Arch Pediatr Adolesc Med. 1995;149(7):817-818. doi:10.1001/archpedi.1995.02170200107018

A 9-MONTH-OLD boy was referred to a geneticist for evaluation of developmental delay and brachycephaly. Five months prior to his visit, he refused to move one arm, then stopped moving both legs. He could not sit independently and appeared to be in pain when lifted. On examination, the patient had perior-bital edema, diffuse cervical and right inguinal lymphadenopathy, and hepatosplenomegaly. Neurological examination demonstrated decreased head control, decreased strength, and refusal to bear weight. A complete blood cell count showed a hemoglobin level of 52 g/L, a white blood cell count of 0.06×109/L, and a platelet count of 0.03×109/L. The patient was referred to the Department of Hematology-Oncology, and a bone marrow examination showed a blast cell count of 0.33. The diagnosis of acute myeloid leukemia FAB type M4 was made. Radiographs of the chest (Figure 1) and left humerus (Figure 2) and a computed tomographic