B63-02 When the Abdomen Points to the Lungs: From Incidental Finding to Critical Illness in a Toddler

Abstract Abdominal pain is a frequent reason for pediatric emergency department visits, yet determining its underlying cause can be challenging. In children, respiratory conditions such as pneumonia can present with abdominal pain or decreased appetite. These signs are thought to result from irritation of the diaphragm or referred pain, and can confuse the initial diagnosis. Early recognition of these unusual presentations is important because delays can lead to complications including parapneumonic effusions, empyema, or severe infections.Here we present a previously healthy 3-year-old male who presented to the emergency department (ED) with a two-day history of diffuse abdominal pain. He had presented to the ED the previous day with similar complaints, received an initial diagnosis of gastritis, was managed symptomatically with improvement, and discharged. Following discharge, the patient’s symptoms worsened, leading to a return visit. The abdominal pain was accompanied by decreased oral intake and general malaise, but no fever, cough, or rhinorrhea. On examination, there was mild diffuse abdominal tenderness without guarding or rebound. Laboratory evaluation demonstrated leukocytosis and thrombocytosis.Due to persistent abdominal pain that did not improve after treatment, an abdominal CT scan was performed, revealing moderate stool burden, and also an incidental left lower lobe pulmonary consolidation with trace pleural effusion. The patient was admitted to the pediatric ward for bowel cleanout and initiated on empiric antibiotic therapy. Within 12 hours of admission, the patient developed tachypnea, hypoxemia, and increased work of breathing. On auscultation, the left lung had diffuse crackles. Repeat chest X-rays and CT scan showed progression of consolidation with increase in the pleural effusion. As the patient required higher levels of care, he was transferred to the pediatric intensive care unit. Antibiotic therapy was escalated to Cefepime and Clindamycin, along with supportive treatment, including nebulized saline and chest physiotherapy. Interventional radiology was consulted for possible image-guided thoracentesis, but as the pleural effusion was not loculated, empyema was ruled out and drainage was not performed; antibiotics were maintained with adequate clinical improvement. The patient was followed up with imaging every other day and transferred to the pediatric ward for follow-up care. The patient gradually improved, with normalization of laboratory parameters, and imaging confirmed complete resolution of pleural effusion; was discharged and outpatient follow-up was coordinated. This case highlights an uncommon presentation of lower lobe pneumonia manifesting solely as abdominal pain in a child, emphasizing the importance of considering pulmonary causes in atypical pediatric abdominal pain. This abstract is funded by: None