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A 20-month-old boy brought to the emergency department with swelling on the right side of the neck and fever (temperature, 39.3°C [102.7°F]) of 1 day’s duration. The parents reported that the child had had intermittent fevers and poor weight gain for the past 3 months but no vomiting, diarrhea, rash, drooling, or difficulty in swallowing.

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Complete duplication of the left thumb in a baby boy was noted at birth; a radiograph of the thumb showed 2 proximal and distal phalanges with 1 first metacarpal bone. He also had fusion and incomplete bony duplication of the right thumb; a radiograph of this digit showed normal proximal and distal phalanges plus a small tiny bony remnant of the proximal and distal phalanges of an accessory thumb.

Imagine that you are working in an outpatient pediatric practice one morning when a mother arrives with her 3-month-old infant who is in respiratory florid distress.