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:
- What does the case image show?
- What should you do next?
- Want a 1-minute consult/tutorial on this case?
- Want to know what happened with this patient?
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ANSWERS:
- What does the case image show? The image shows a massively infarcted spleen with enhancement only at the tip.
- What should you do next? Admit to work up for a hypercoaguable state
- Want a 1-minute consult/tutorial on this case? See yellow area from sample page below.
- 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