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LLQ Pain & Jaundice

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History of Present Illness:

A 42-year-old male presents to the ED for for 5 days of intermittent gradually worsening left lower quadrant abdominal pain with no associated fever, vomiting, diarrhea, dysuria, hematuria or other complaints. He has never had this before and it is getting worse.  His wife also says his eyes look yellow.

He denies any or other complaints

Vital Signs & Physical Exam:

Vital signs are normal

Physical exam is normal except for LLQ tenderness with mild guarding.  There is no noticeable jaundice.

Initial Differential Diagnosis:

  • Diverticulitis
  • Kidney stone
  • Constipation
  • Syphilis, the great imitator

Initial Diagnostic Testing:

  • Labs: LFTs, CBC and lipase were all normal
  • Imaging: Since the patient had never had this before and since 5 days in it was getting worse, a CT was ordered, even though it was thought it would be low yield.

QUESTIONS:

  1. What does the case image show?  
  2. What should you do next?  
  3. Want a 1-minute consult/tutorial on this case? 
  4. Want to know what happened with this patient?

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ANSWERS:

  1. What does the case image show?  The image shows a lesion suspicious for a renal cell carcinoma in the right kidney.  No cause for the patient’s pain was found .
  2. What should you do next?  Arrange follow-up with GI and with urology
  3. Want a 1-minute consult/tutorial on this case?  See yellow area from sample page below.
  4. Want to know what happened with this patient?  See case conclusion below tutorial page.

1-Minute EM Consult on the topic for this case from the Emergency Medicine 1-minute Consult Pocketbook

 

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CASE CONCLUSION: Close follow up was arranged

CASE LESSONS:

  1. Always
  2. Never
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