Volume 1, Case 4

Persistent Abdominal Pain Radiology Cases in Pediatric Emergency Medicine Volume 1, Case 4 Loren G. Yamamoto, MD, MPH

A nearly 8 year old female came to the ED with a chief complaint of stomach aches for one week. These pains would come and go and were best characterized as crampy in nature with no particular location. She also complained of back aches since her ballet stretching exercises yesterday. There was no history of fever, nausea, vomiting, diarrhea, or respiratory symptoms. Her bowel movements were regular and soft.

Exam: VS T36.8, P98, R24, BP 114/88. She was alert, cooperative, and somewhat anxious. HEENT exam was unremarkable. Neck supple without adenopathy. Heart regular without murmurs. Lungs clear. Abdomen was soft, flat, and non-tender. There was no rebound. Bowel sounds were active. No masses or hepatosplenomegaly were appreciated. A rectal exam revealed no stool in the rectum and no masses. She was observed to have more pain when standing or when sitting up. There was no CVA tenderness. Left flank pain and epigastric pain were elicited on straight leg raising.

An abdominal series was obtained.

X-Ray

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This radiograph was initially read as showing non-specific findings. Other laboratory results: CBC WBC 2.9, 32 segs, 64 lymphs, 4 monos, Hgb 12.4, Hct 36.5, platelets adequate. Amylase 123, SGOT 24.

Her pain persisted, and review of her radiographs revealed subtle compression fractures of the vertebral bodies. Follow-up radiographs were obtained.

View follow-up radiographs.

AP

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What is your diagnosis?

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Loren Yamamoto, MD, MPH 
Associate Professor of Pediatrics
University of Hawaii John A. Burns School of Medicine
loreny@hawaii.edu