Volume 1, Case
3
Abdominal Pain with a Negative
Abdominal Examination Radiology Cases in Pediatric Emergency Medicine
Volume 1, Case 3 Loren G. Yamamoto, MD, MPH
A 6 year old male presents
to the ED with a chief complaint of fever and stomach pain since last
night. It is now 11:00 a.m. The temperature was not measured at home but
he felt warm. He was given an unspecified dose of acetaminophen at 4:00
a.m. There was no history of nausea, vomiting, or diarrhea. His last bowel
movement was three days ago. He pointed to his epigastrium as the location
of most of his pain.
Exam: VS T38 (tympanic), P136,
R24, BP 113/61. He was noted to be small for age (19.3 kg), alert, active,
in no distress. He did not appear to be uncomfortable at all. HEENT exam
was unremarkable. Neck supple without adenopathy. Heart regular without
murmurs. Lungs clear. Abdominal exam was positive for mild tenderness
in the epigastrium. Bowel sounds were active. No tenderness in the right
lower quadrant. No rebound tenderness. No hepatosplenomegaly or masses
were appreciated. Testes were normal. A rectal exam revealed normal sphincter
tone, no masses, and no right lower quadrant tenderness. The stool tested
negative for occult blood. An abdominal series was ordered. An AP view
of the chest was also ordered as part of the abdominal series.
Flat
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Upright
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Chest
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The radiographs were interpreted
as showing non-specific findings. Because the cause of the abdominal pain
was suspected to be constipation, the patient was given an enema. Following
this, he passed a large amount of stool and felt much better. His abdominal
exam continued to be benign. He was discharged from the ED. Overnight,
the patient continued to experience fever at home and some abdominal pain
though the degree of abdominal pain was improved. A review of his radiographs
the following morning revealed an alternative diagnosis for his symptoms.
Review his abdominal series
again.
If you are still unable to
identify the radiographic diagnosis, review the focused enlarged view
of the lesion.
What is your Diagnosis?
Click here
for the answers to Case 3
Loren Yamamoto, MD, MPH
Associate Professor of Pediatrics
University of Hawaii John A. Burns School of Medicine
loreny@hawaii.edu
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