Ultrasound Case of the Week #15
Chief Complaint: “Abdominal Pain”
HPI: Pt. is a 4 year old female who has experienced several days of diffuse abdominal pain. Two days ago she had an episode of emesis, however, the morning prior to presentation was more playful, taking PO and acting at her baseline. She has had intermittent low grade fevers, maximum of which was 101 over the last 4 days. She has had no diarrhea, rash, respiratory symptoms, urinary symptoms, and otherwise has looked reasonably well. She denies anorexia.
ROS: The rest of a comprehensive ROS is negative.
PMH: unremarkable. Birth history unremarkable.
Meds: A few doses of ibuprofen for fever and abdominal pain over the last few days.
SH: Lives with mother and father and one sister. No daycare, no tobacco exposure. Shots UTD. No foreign travel.
PE:
Vital Signs: Temp 99.4 Pulse 110 Respirations 15 BP 95/71
General: Slightly uncomfortable on stretcher but nontoxic in appearance.
HEENT: PERRLA, anicteric, OP clear, Tm's clear..
Lungs: CTAB.
Cardiovascular: RRR without MRG.
Abdomen: Mild localized tenderness in the RLQ that the child is able to point to. BS presents and normoactive. No rebound or guarding is present.
Musculoskeletal: No clubbing, cyanosis, or edema.
Neurological: AO X3, Strength 5/5 bilaterally.
Relevant Workup:
Cath UA- 0-5 WBC, tr bacteria, no LE, no nitrite.
BMP - CO2 -22 otherwise normal.
CBC - white count 11k, Hb 13, Plt 200k.
A curious attending and resident proceeded with a bedside sonogram of the abdomen in the location where the patient had pain…
To the US!
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