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LUQ Pain

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History of Present Illness:

A 52-year-old male with a history of CAD, hypertension, hyperlipidemia and amphetamine abuse presents to the ED with left-sided abdominal pain starting 8 hours ago this morning.  No associated nausea, vomiting, fever, melena, bleeding, diarrhea or constipation or other symptoms.  No SOB but pain is mildly pleuritic

Vital Signs & Physical Exam:

Vital signs are normal except for mildly elevated BP.   Physical exam is otherwise normal except for LUQ tenderness

Initial Differential Diagnosis:

  • ACS, gastritis, kidneys stone, splenomegaly, PE

Initial Diagnostic Testing:

  • EKG: unchanged from baseline
  • Labs: WBC elevated a 13 with a few atypical lymphs, CRP, sed rate, UA and troponin all normal
  • Imaging: see below

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?

SCROLL DOWN FOR ANSWERS & 1-MINUTE CONSULT

 

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ANSWERS:

  1. What does the case image show?  The image shows a massively infarcted spleen with enhancement only at the tip.
  2. What should you do next?  Admit to work up for a hypercoaguable state
  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: We’ll just have to see

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