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…
please interpret the CXR. what’s on your differential diagnosis? what the most likely diagnosis? how are you going to manage this patient?
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jwang
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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.
I agree with Sally. Abdominal CT if hemodynamically stable, laparotomy if unstable.