Triage:  “I woke up with severe back pain”.  States he thinks its from working, bending and twisting. Low back, both sides.  No pain in legs or abdomen

History of Present Illness:  A man in his mid 50’s whose has had about a month of body aches and mid back back pain associated with some cough.  No diarrhea but has had some abdominal discomfort as well. Pain is worse with activity and back pain recently got worse.  He thinks he may have injured it at work.  No other complaints. No numbness or weakness or symptoms in his legs. No injections.

Vital Signs & Physical Exam: T: 37.5 °C, HR: 75,  RR: 18, BP: 116/74, SpO2: 98%

°GENERAL: Alert, calm, conversant in NAD
°EYES: Clear without discharge. No photophobia
°LUNGS: Unlabored respirations. No splinting. No rales. No wheezing.
°HEART: Normal rate. Regular. Normal heart sounds.
°ABDOMEN: Soft, mild upper-tender. No guarding. No rebound
°GENITOURINARY: Mild bilateral CVAT
°SPINE: No deformity noted.
°EXTREMITIES: No edema. No tenderness. Homan´s negative. Symmetric pulses
°NEUROLOGIC: Normal speech. No focal weakness. Alert and oriented.

Testing:

  • Chest x-ray normal.
  • Inflammatory markers elevated with white count of 15 sed rate 58.
  • LFTs elevated with ALT 104 AST 58 and alk phos otherwise also elevated.
  • CT with contrast image below

What is the most likely diagnosis?

  • A) Fatty liver
  • B) Cholecystitis
  • C) AAA
  • D) None of the above

SCROLL DOWN FOR ANSWERS & 1-MINUTE CONSULT

 

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QUIZ ANSWER:

  • A) Fatty liver
  • B) Cholecystitis
  • C) AAA
  • D) None of the above

1-Minute Consult on this topic: Click HERE and go to page 148

 

CASE CONCLUSION: MULTILOCULAR INTRAHEPATIC BILOMA AND POSSIBLE ABSCESS ANTERIOR LIVER WITH ADJACENT GALLBLADDER FOSSA AND PORTA HEPATIS FAT STRANDING. SMALL STONE OBSTRUCTING THE DILATED CYSTIC DUCT

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ULTRASOUND-GUIDED PERCUTANEOUS DRAINAGE CATHETER PLACEMENT PERFORMED INTO A MEDIAL RIGHT HEPATIC LOBE FLUID COLLECTION, LIKELY AN ABSCESS. SPECIMEN OF PURULENT BLOODY FLUID SENT FOR MICROBIOLOGY EVALUATION. TUBE CONNECTED TO JP BULB SUCTION.

 

Staph Aureus grew in blood and IR drainage