Tuesday, May 10, 2011

May Case #1: Abdominal Pain

40 y/o AAF presents with c/o abdominal pain, constipation and occasional vomiting over approximately 1-2 days.  She also c/o generalized weakness and occasional headaches with blurry vision.
PMHx:  Leukemia (last chemo about 2 months prior), chronic pain syndrome, depression
Meds:  oxycontin, lortab, stool softener
SocHx:  denies tobacco or ETOH
FamHx:  HTN, DM
All: NKDA

PE: BP 110/62, P 89, R 20, T 99, POx 99%
GEN: WNWD, AAF, moderate distress
CHEST:  CTA B, non labored
CV:  RRR, no M/R/G
ABD:  distended, fullness in L hemi-abdomen with diffuse TTP, no rebound or guarding, +BS
EXT:  no C/C/E
SKIN:  no rashes noted

Bedside ultrasound is performed:





 




What is the abnormality visualized here?
What is the diagnosis?

Special thanks to Dr. Erin McBride for this case write up!
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2 comments:

  1. AnonymousMay 12, 2011 at 11:30 AM

    So, I only see Flow in one direction, (BART), given her previous dx of CA, she is at higher risk for hyper-coaguable state, probably a Splenic Arterial Thrombosis?

    -Steve M

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  2. FaheemMay 20, 2011 at 12:47 PM

    That's a good one! Mono? Or maybe Budd Chiari causing splenomegaly. Also if her wbc is elevated in relation to her leukemia she could get splenic congestion from that.

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