XRay Vision: So Much Abdominal Pain

47 years old male with no PMH presents with one day of severe epigastric pain. States that he had this type of pain before, and his PMD prescribed him “some pills” that helped with the pain. But he no longer takes the medication. You get a CXR and you see…

cxr cxr2

 

please interpret the CXR. what’s on your differential diagnosis? what the most likely diagnosis? how are you going to manage this patient?

The views expressed on this blog are the author's own and do not reflect the views of their employer. Please read our full disclaimer here. Any references to clinical cases refer to patients treated at a virtual hospital, Janus General Hospital.
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jwang

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2 comments for “XRay Vision: So Much Abdominal Pain

  1. sliang
    August 15, 2014 at 10:27 pm

    PA and lateral CXR: Adequate penetration, lung volume, and position. Trachea midline. No bony abnormalities. FREE AIR UNDER DIAPHRAGM. No subcutaneous emphysema. No other acute cardiopulmonary processes.

    Most likely perforated peptic/duodenal ulcer. Other possible but less likely diagnoses include: other ruptured hollow viscus such as a ruptured diverticulum, bowel obstruction, Chilaiditi syndrome, penetrating abd trauma, post-surgical/laparascopic/endoscopy complications.

    A, B, C, IV, O2, monitor. Pre-op labs, abx, consult surgery stat and transfer to CCT, admit.

  2. Nathan
    August 20, 2014 at 9:53 am

    I agree with Sally. Abdominal CT if hemodynamically stable, laparotomy if unstable.

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