LUQ Pain
UnFiNiShEd CaSe CoMe BaCk LaTeR
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History of Present Illness:
A 22-year-old female presents to the ED for a year of intermittent left rib and left upper quadrant pain with no associated symptoms. It has been worse recently but is not pleuritic or exertional and has no triggers. There is no associated vomiting, diarrhea, fever, dysuria, discharge, shortness of breath or other complaints.
Vital Signs & Physical Exam:
Vital signs are normal. Physical exam is otherwise normal except for left anterior rib tenderness. No rash
Initial Differential Diagnosis: Syphilis the great imitator, PE, gastritis, kidney stone
Initial Diagnostic Testing:
- Labs: CBC, BMP, LFT, D-dimer, HCG 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 mild splenomegaly. Normal is <12cm in longest dimension with 12-14cm being borderline enlarged and >14cm definitely enlarged.
- What should you do next? Refer for workup of cause
- 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.
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CASE CONCLUSION: Patient was referred to hematology for a work up of the cause.
CASE LESSONS: