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. There is no associated nausea, vomiting, fever, melena, bleeding, diarrhea or constipation or other symptoms. He denies SOB but the 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 Diagnostic Testing:
- EKG: unchanged from baseline
- Labs: WBC elevated a 13. CRP, sed rate, UA and troponin all normal
- Imaging: see below
What is the most likely diagnosis?
- A) ACS
- B) Gastritis
- C) Kidney stone
- D) Splenic infarct
- E) PE
SCROLL DOWN FOR ANSWERS & 1-MINUTE CONSULT
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ANSWERS: What is the most likely diagnosis?
- A) ACS
- B) Gastritis
- C) Kidney stone
- D) Splenic infarct – CORRECT – The image shows an enlarged and mostly infarcted spleen with contrast enhancement only at the tip (whiter area).
- E) PE
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CASE CONCLUSION: Admitted for hypercoagulable workup