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

History of Present Illness:  A man in his mid 50’s 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: T: 37.5 °C, HR: 75,  RR: 18, BP: 116/74, SpO2: 98%

Physical Exam

°ABDOMEN: Soft, mild upper-tender. No guarding. No rebound
°GENITOURINARY: Mild bilateral CVAT
°SPINE: No deformity noted.
°EXTREMITIES: No edema.  Symmetric pulses
°NEUROLOGIC: Normal speech. No focal weakness.

Testing:

  • CBC: WBC 15, sed rate 58
  • LFT: ALT 104, AST 58, and alk phos mildly 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 – CORRECT

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

 

CASE CONCLUSION:

  • CT READ: Multilocular intrahepatic biloma and possible abscess anterior liver with adjacent gallbladder fossa and porta hepatis fat stranding. Small stone obstructing a dilated cystic duct

.

  • IR PROCEDURE: Ultrasound-guided percutaneous drainage catheter placed into right hepatic lobe fluid collection, likely an abscess.  Purulent bloody fluid
  • CULTURES: Staph Aureus grew in blood and abscess