Pseudoparalysis of parrot - Re-emergence of the great mimicker.

We present the case of a 2-month-old adopted female seeking evaluation in the pediatric emergency department due to a one-day history of decreased right arm movement and fussiness. The physical exam was largely unremarkable with the exception of decreased spontaneous movement of the right upper extremity, obvious discomfort with passive movement and subtle edema of the forearm. Because of concern for non-accidental trauma, plain films were obtained which revealed no signs of traumatic injury. Subsequently, a broader investigation ensued with infectious etiologies in mind. Laboratory evaluation demonstrated anemia, transaminitis, and elevated inflammatory markers. These abnormalities led to the consideration of congenitally acquired infections, specifically syphilis, and serologies were confirmatory. Ultimately, the infant was diagnosed with Pseudoparalysis of Parrot - a rare musculoskeletal manifestation secondary to painful syphilitic periostitis. As Emergency Medicine physicians, it is important to be aware of the growing burden of syphilis infection and reacquaint ourselves with its numerous presentations in the young infant.

Awareness of radiation risks from CT scans among patients and providers and obstacles for informed decision-making.

INTRODUCTION: Using the study design from a prominent 2004 study, we aimed to reassess patient, provider, and radiologist awareness of CT radiation more than a decade later. METHODS: Adults presenting to the emergency department of a tertiary care center over a 2-week period with mild to moderate pain requiring an abdominopelvic CT scan were surveyed. Patients were asked if anyone had discussed the risks/benefits of the CT scan including radiation dose and were asked to estimate their dose compared to a chest X-ray. Emergency providers and radiologists were given similar surveys and were asked about potential obstacles to discussing CT radiation with patients. RESULTS: A total of 101 patients, 570 emergency providers, and 161 radiologists were surveyed. Twenty-three percent (14/61) of patients, 39% (219/568) of emergency providers, and 48% (77/161) of radiologists correctly selected the radiation dose range of an abdominopelvic CT. Seventy-eight percent (441/567) of emergency providers reported routinely discussing radiation dose with patients, while 20% (20/98) of patients reported that their emergency provider discussed radiation dose with them. Time limitation and concern of dissuading the patient from CT were the most commonly reported obstacles for discussing risks. CONCLUSIONS: Patients and providers in 2015 appear to be more aware of radiation dose from CT than they were in 2004. Discussion of CT scan radiation exposure and associated risks only occurs sometimes and may actually occur less frequently than perceived by emergency providers.