Netter's Pediatrics, 1e (Netter Clinical Science)

858 Pages·2012·41.47 MB·English

The ultimate Netter
Collection is back!
Netter’s timeless work, now arranged
and informed by modern text and
radiologic imaging!
The long-awaited update of The Netter Collection of Medical
Illustrations, also known as the CIBA “green books,” is now
becoming a reality! Master artist-physician, Carlos Machado,
and other top medical illustrators have teamed-up with
medical experts to make the classic Netter “green books” a
reliable and effective current-day reference.
(cid:115) Apply a visual approach—with the classic Netter art, updated
illustrations, and modern imaging-- to normal and abnormal body
function and the clinical presentation of the patient.
(cid:115) Clearly see the connection between basic and clinical sciences
with an integrated overview of each body system.
(cid:115) Get a quick understanding of complex topics through a concise
text-atlas format that provides a context bridge between general and
specialized medicine.
ORDER YOURS TODAY!
Learn more about the series at www.NetterReference.com/greenbooks
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E DITIO N! Professional Edition
Frank H. Netter, MD
May 2010. 978-1-4377-0970-4.
The Netter Atlas is your authoritative guide to the human body–through versatile print
and online resources. The new 5th Edition features a stronger clinical focus than ever
before, including an online image bank of some of Netter’s classic anatomy and pathology
illustrations, diagnostic imaging examples, and videos from Netter’s 3-D Interactive Anatomy.
ORDER TODAY! mynetter.com 1-800-545-2522
Netter’s
Pediatrics
EDITORS ASSOCIATE EDITORS
TODD A. FLORIN, MD PAUL L. ARONSON, MD
Fellow, Division of Pediatric Emergency Fellow, Division of Pediatric Emergency
Medicine Medicine
The Children’s Hospital of Philadelphia The Children’s Hospital of Philadelphia
Instructor, Department of Pediatrics Instructor, Department of Pediatrics
The University of Pennsylvania School The University of Pennsylvania School
of Medicine of Medicine
Philadelphia, Pennsylvania Philadelphia, Pennsylvania
STEPHEN LUDWIG, MD HEIDI C. WERNER, MD
Senior Advisor for Medical Education Fellow, Division of Emergency Medicine
John H. and Hortense Cassell Jensen Endowed Children’s Hospital Boston
Chair Instructor of Pediatrics
The Children’s Hospital of Philadelphia Harvard Medical School
Professor of Pediatrics and Emergency Medicine Boston, Massachusetts
The University of Pennsylvania School
of Medicine
Philadelphia, Pennsylvania
Illustrations by Frank H. Netter, MD
CONTRIBUTING ILLUSTRATORS
Carlos A. G. Machado, MD
John A. Craig, MD
James A. Perkins, MS, MFA
Tiffany S. DaVanzo, MA, CMI
Anita Impagliazzo, MA, CMI
1600 John F. Kennedy Blvd.
Ste 1800
Philadelphia, PA 19103-2899
NETTER’S PEDIATRICS ISBN: 978-1-4377-1155-4
Copyright © 2011 by Saunders, an imprint of Elsevier Inc.
No part of this publication may be reproduced or transmitted in any form or by any means, electronic
or mechanical, including photocopying, recording, or any information storage and retrieval system,
without permission in writing from the publisher. Details on how to seek permission, further
information about the Publisher’s permissions policies and our arrangements with organizations such as
the Copyright Clearance Center and the Copyright Licensing Agency, can be found at our website:
www.elsevier.com/permissions.
Permissions for Netter Art figures may be sought directly from Elsevier’s Health Science Licensing
Department in Philadelphia PA, USA: phone [phone], ext. 3276 or [phone]; or email
[email protected].
This book and the individual contributions contained in it are protected under copyright by the
Publisher (other than as may be noted herein).
Notices
Knowledge and best practice in this field are constantly changing. As new research and experience
broaden our understanding, changes in research methods, professional practices, or medical
treatment may become necessary.
Practitioners and researchers must always rely on their own experience and knowledge in
evaluating and using any information, methods, compounds, or experiments described herein. In
using such information or methods they should be mindful of their own safety and the safety of
others, including parties for whom they have a professional responsibility.
With respect to any drug or pharmaceutical products identified, readers are advised to check the
most current information provided (i) on procedures featured or (ii) by the manufacturer of each
product to be administered, to verify the recommended dose or formula, the method and duration
of administration, and contraindications. It is the responsibility of practitioners, relying on their own
experience and knowledge of their patients, to make diagnoses, to determine dosages and the best
treatment for each individual patient, and to take all appropriate safety precautions.
To the fullest extent of the law, neither the Publisher nor the authors, contributors, or editors,
assume any liability for any injury and/or damage to persons or property as a matter of products
liability, negligence or otherwise, or from any use or operation of any methods, products,
instructions, or ideas contained in the material herein.
ISBN: 978-1-4377-1155-4
Acquisitions Editor: Elyse O’Grady
Developmental Editor: Marybeth Thiel
Editorial Assistant: Chris Hazle-Cary
Publishing Services Manager: Patricia Tannian
Senior Project Manager: John Casey
Designer: Steven Stave
Working together to grow
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Printed in United States of America www.elsevier.com | www.bookaid.org | www.sabre.org
Last digit is the print number: 9 8 7 6 5 4 3 2 1
About the Editors
Stephen Ludwig, MD, is Senior Advisor for Medical Educa- He was a resident in Pediatrics from 2005-2008 and Chief
tion and Senior Attending Physician at The Children’s Hospital Resident from 2008-2009 at The Children’s Hospital of Phila-
of Philadelphia, Department of Pediatrics. He is the Chairman delphia. In addition to his fellowship training, he is currently
of the Graduate Medical Education Committee and Designated pursuing his masters of science in clinical epidemiology at
Institutional Official. Dr. Ludwig holds the John H. and the Center for Clinical Epidemiology and Biostatistics at The
Hortense Cassell Jensen Endowed Chair. In addition, he is University of Pennsylvania School of Medicine. Dr. Florin is
a Professor of Pediatrics and Emergency Medicine at The the recipient of a Young Investigator Award from the Academic
University of Pennsylvania School of Medicine. Pediatric Association and a grant from the Loan Repayment
Dr. Ludwig is a past president of the Academic Pediatric Program of the National Institutes of Health. After completing
Association (APA) and a member of the Board of Directors, as fellowship, Dr. Florin intends to pursue an academic career
well as a founding member of the Pediatric Emergency Medi- combining clinical pediatric emergency medicine, medical
cine Special Interest Group. He is a member of the Interna- education, and research in pediatric acute care epidemiology.
tional Society of Child Abuse and Neglect. Dr. Ludwig is a He continues to be an active singer and conductor and has
founding member of the Ray Helfer Society. Currently, he just completed his eighth summer season as a principal con-
serves as Chairman of the Residency Review Committee (RRC) ductor with the College Light Opera Company in Falmouth,
for Pediatrics of the Accreditation Council for Graduate Medical Massachusetts.
Education (ACGME). He has been a member of the Board of Paul L. Aronson, MD, received his bachelor of arts in
Directors of the American Board of Pediatrics and was Chair of drama from Duke University and his medical degree from
the Program Directors Committee until 2009. He has received New York University. He completed his residency and chief
many awards from The University of Pennsylvania, Association residency in pediatrics at The Children’s Hospital of Philadel-
of Pediatric Program Directors (APPD), and APA. He was phia, at which he is currently a fellow in pediatric emergency
elected to the Institute of Medicine in 1998. Recently, Dr. medicine. His main academic interest is in medical education
Ludwig has been selected by the Board of Directors of the with a particular focus on evidence-based medicine. He is the
Federation of Pediatric Organizations as the recipient of the recipient of the senior resident and fellow teaching awards from
2010 Joseph W. St. Geme, Jr. Leadership Award. the residency program at The Children’s Hospital of Philadel-
Dr. Ludwig has over 150 publications to his credit and serves phia. He lives in Philadelphia with his wonderful wife, Jenny (a
on several editorial boards. He is Co-Editor in Chief of Pediatric fifth grade teacher), and their two loving cats, Emma and Duke.
Emergency Care. He is the Editor of the Textbook of Pediatric He would especially like to thank his parents for their support
Emergency Medicine, now in its sixth edition. and for teaching him that true success is measured by character
Dr. Ludwig received his medical degree from Temple Uni- and a happy family.
versity School of Medicine and completed his pediatric intern- Heidi C. Werner, MD, is currently a senior fellow in
ship and residency at the Children’s Hospital National Medical Pediatric Emergency Medicine at The Children’s Hospital
Center in Washington, DC. He holds board certification in Boston. Dr. Werner graduated from Princeton University with
General Pediatrics and certificate 001 in Pediatric Emergency a bachelor of arts in molecular biology and received her medical
Medicine from the American Board of Pediatrics. degree from Columbia College of Physicians and Surgeons. She
Todd A. Florin, MD, is currently a senior fellow in Pediatric was a resident in pediatrics from 2005-2008 and Chief Resident
Emergency Medicine at The Children’s Hospital of Philadel- from 2008-2009 at The Children’s Hospital of Philadelphia.
phia. Dr. Florin graduated from the University of Rochester After fellowship training, Dr. Werner intends to pursue an aca-
with a bachelor of arts in music with a vocal performance demic career combining clinical pediatric emergency medicine,
and conducting focus and received his medical degree from medical education ,and research in pediatric bedside emergency
the University of Rochester School of Medicine and Dentistry. ultrasound.
vi  SECTION XV • Infectious Disease
About the Artists
Frank H. Netter, MD anatomy atlas of choice among medical and health professions
Frank Netter was born in 1906, in New York City. He students the world over.
studied art at the Art Student’s League and the National The Netter illustrations are appreciated not only for their
Academy of Design before entering medical school at New aesthetic qualities, but, more important, for their intellectual
York University, where he received his MD degree in 1931. content. As Dr. Netter wrote in 1949, “… clarification of a
During his student years, Dr. Netter’s notebook sketches subject is the aim and goal of illustration. No matter how beauti-
attracted the attention of the medical faculty and other physi- fully painted, how delicately and subtly rendered a subject may
cians, allowing him to augment his income by illustrating be, it is of little value as a medical illustration if it does not serve
articles and textbooks. He continued illustrating as a sideline to make clear some medical point.” Dr. Netter’s planning, con-
after establishing a surgical practice in 1933, but he ultimately ception, point of view, and approach are what inform his paint-
opted to give up his practice in favor of a full-time commit- ings and what makes them so intellectually valuable.
ment to art. After service in the United States Army during Frank H. Netter, MD, physician and artist, died in 1991.
World War II, Dr. Netter began his long collaboration Learn more about the physician-artist whose work has inspired
with the CIBA Pharmaceutical Company (now Novartis the Netter Reference collection: http://www.netterimages.com/
Pharmaceuticals). This 45-year partnership resulted in the artist/netter.htm.
production of the extraordinary collection of medical art
so familiar to physicians and other medical professionals Carlos A. G. Machado, MD
worldwide. Carlos Machado was chosen by Novartis to be Dr. Netter’s suc-
In 2005, Elsevier, Inc., purchased the Netter Collection and cessor. He continues to be the main artist who contributes to
all publications from Icon Learning Systems. There are now the Netter collection of medical illustrations.
over 50 publications featuring the art of Dr. Netter available Self-taught in medical illustration, cardiologist Carlos
through Elsevier, Inc. (in the US: www.us.elsevierhealth.com/ Machado has contributed meticulous updates to some of Dr.
Netter and outside the US: www.elsevierhealth.com). Netter’s original plates and has created many paintings of his
Dr. Netter’s works are among the finest examples of the use own in the style of Netter as an extension of the Netter collec-
of illustration in the teaching of medical concepts. The 13-book tion. Dr. Machado’s photorealistic expertise and his keen insight
Netter Collection of Medical Illustrations, which includes the into the physician/patient relationship informs his vivid and
greater part of the more than 20,000 paintings created by Dr. unforgettable visual style. His dedication to researching each
Netter, became and remains one of the most famous medical topic and subject he paints places him among the premier
works ever published. The Netter Atlas of Human Anatomy, first medical illustrators at work today.
published in 1989, presents the anatomical paintings from the Learn more about his background and see more of his art at:
Netter Collection. Now translated into 16 languages, it is the http://www.netterimages.com/artist/machado.htm.
Preface
This book serves as a tribute to medical education and mentor- something of enduring value as a team. Although all of our
ing in all its forms. It spans a cycle of mentoring that began for careers have moved forward in new directions, this was a chance
me more than 40 years ago. It underscores the value of the to hold on to a certain chemistry we shared. This is the first
mentoring process from that time to today. major textbook that will bear their names, but you will hear their
More than 40 years ago, as a medical student, I relied on the names often in the future, as I am certain they will be leaders
masterful work of Frank Netter. In every sense he seemed like in pediatrics. This may be their first book, but I assure you it
a helpful sage mentor. Learning from other standard textbooks will not be their last.
was certainly possible, but the Netter drawings took me by the When formulating our concepts of the book, we decided to
hand, opened my mind to anatomy, physiology, pathogenesis, make it a mentoring project in itself. All of the chapters were
and clinical signs and symptoms in a very personal way. Gray’s written by more-junior faculty, fellows, and residents. Each was
Anatomy Textbook had all the detail, but studying it felt almost supervised by a section editor who helped these young but tal-
austere, untouchable. Frank Netter was warm and welcoming ented authors get their chapters written, edited, and into print.
the way any good mentor establishes a positive learning envi- For some authors this represents their first major publication.
ronment. Dr. Netter and those who followed him taught entire For many there were lessons learned along the way. For all
generations of physicians through the 1960s, 1970s, and 1980s. there was a chance to build a relationship with a more senior
The old adage that a picture is worth a thousand words was section editor. To these section editors we owe a great debt of
multiplied many times over by a Netter illustration. When gratitude.
offered the opportunity to co-edit this book, which might help With all the technologic advances in medicine and our deep-
to recirculate the Netter illustrations, it was my immediate reac- ening understanding of the basis of diseases and therapeutics,
tion to sign on. Our hope was that these illustrations would be we are all still benefiting from the time-worn traditions of medi-
available to touch the lives of the next generations of pediatric cine. Netter’s Pediatrics showed us the way. Senior faculty working
trainees. one on one with more-junior people. Mentoring — the appren-
However, this volume had other mentoring dimensions as ticeship model — still at the heart of our academic process.
well. First was the opportunity to work with three outstanding Our hope is that this volume will aid you in the care of chil-
chief residents, Todd Florin, MD, the co-editor, and Paul dren. We hope these words and drawings will bring the subject
Aronson, MD, and Heidi Werner, MD, the two associate matter alive and help you derive as much practice knowledge
editors. Having worked with them over three years of pediatric and pleasure from using Netter’s Pediatrics as we experienced in
residency at The Children’s Hospital of Philadelphia and during bringing it to you.
one additional year as chief residents, the choice to continue our Stephen Ludwig, MD
collaboration was a mentor’s dream. It was a chance to produce Philadelphia, 2011
viii  SECTION XV • Infectious Disease
Dedication
To my families—
The one at home and the one at work.
I am ever grateful to both.
SL
To
My patients, you are my greatest educators
My teachers, you are my inspiration
My parents, you are my foundation
My wife, Kemper, you are my rock
TAF
To my beautiful and very patient best friend and wife, Jenny.
You make me a better person, and everything I do is possible
because of your love and support.
To my family and family-in-law, I am truly grateful for your love
and generosity.
To my many teachers, mentors, and colleagues at The
Children’s Hospital of Philadelphia, from whom I have
learned so much.
To my patients, who have ultimately taught me everything I
know in pediatrics. It is a true privilege to be a pediatrician.
PLA
To my husband, my parents, and my children for their loving
support.
HCW
Acknowledgments
This is a book of “firsts.” The first time that Frank Netter’s draw- Many of the beautiful images in this book were drawn by
ings of pediatric illness have been brought together in a single Frank Netter. However, many images needed to be edited, and
volume. The first time that many of the young residents and some new images were drawn from scratch. We would like to
fellows represented in this book have written a book chapter. For thank all of the artists that contributed to this book: Jim Perkins,
Dr. Ludwig, the first time that he has collaborated on such a large Tiffany DaVanzo, Anita Impagliazzo, and the DragonFly Media
project with three of his chief residents. For Drs. Florin, Aronson, Group. “A picture is worth a thousand words,” and these tal-
and Werner, the first time they are editing a textbook. “Firsts” are ented artists were incredible in their ability to bring concepts to
exciting—they create an atmosphere of adventure, passion, cau- life through their beautiful artwork.
tious anticipation. They also require significant effort and time, Special thanks go to our editorial team at Elsevier—Anne
often beyond the hours and days of the typical workweek. As a Lenehan Woodcock, Elyse O’Grady, and especially Marybeth
result, many people not directly listed in the pages that follow had Thiel—who were instrumental in guiding us through the pro-
a tremendous impact on the successful production of this book. duction of this first edition of Netter’s Pediatrics. Their encour-
We would first like to thank all of the contributing authors agement and guidance were critical in the process of writing and
and section editors from The Children’s Hospital of Philadel- editing the book.
phia and The University of Pennsylvania School of Medicine. Special recognition goes to Ms. Carolyn Trojan, whose
All of the first authors are residents and fellows at the early extraordinary organizational skills and commitment were vital
stages of their pediatric careers whose passion, intellect, and in producing a new multi-authored textbook.
dedication shine through in the pages that follow. Without their Finally, we would like to extend our most emphatic thanks
hard work, Netter’s Pediatrics could not exist. We would also like to our families, without whom a project of this scope would not
to especially thank the faculty members at our institution that be possible. Without their tremendous love and support, our
served as section editors for this book. These physicians have work would lack meaning. First, we would like to acknowledge
shown a clear and dedicated commitment to mentorship through our spouses—Kemper Florin, Zella Ludwig, Jenny Shieh, and
their contributions and hard work in guiding these young Howard Horn—whose patience, encouragement, support, and
authors through the process of writing this book. love make everything possible. Second, thanks to our children
Our patients and their parents provide continuous inspira- and grandchildren—Susannah Ludwig and Mike Poppleton,
tion and motivation. We thank you all for the privilege to care Elisa Ludwig and Jesse Pires, Aubrey Ludwig and Jared Ellman,
for you and your children and for being our most valued teach- Jack Ellis Poppleton, and Archer and Ella Horn — who chal-
ers. It is primarily our patients that motivate us to produce a lenge us and inspire us to remember the truly important things
volume to teach the current and next generation of pediatric in life. Finally, thanks to our parents who gave us the foundation
health care providers. to become who we are today.