Continued...

View Abdominal Series: Upright view

View Abdominal Series: Supine view

Although there some subtle abnormalities on his CXR, there were no definite abnormalities to account for his grunting and abdominal pain. There were some possible central infiltrates and the right hemidiaphragm appeared to be possibly elevated. The inspiratory effort shown on the film was poor.

This was also noted on the CXR from the rural ED. His abdominal radiographs showed some bowel distention, but consistent with an ileus and not a bowel obstruction. Laboratory results: CBC WBC 33.6, 1 meta, 29 bands, 63 segs, 5 lymphs, 2 monos, Hgb 13.1, Hct 39.0, platelet count 310,000. Na 136, K 4.0, Cl 102, Bicarb 21, glucose 142. UA SG 1.031, 0-2 WBC, 3-5 RBC. An abdominal ultrasound was performed looking for an intra-abdominal abscess. This study showed a suspicious right lower quadrant mass, but it was unable to define it further. A surgical consultation was obtained. The likelihood of acute appendicitis was felt to be low. A CT scan of the abdomen was obtained. This study was unremarkable except for a view of the upper abdomen.

View CT scan

This CT cut is through the upper abdomen. It shows the liver, parts of the diaphragm, and the lower portions of the lungs. Pulmonary infiltrates are noted in the posterior portion of the right lower lobe. Note the pleural effusion adjacent to the infiltrates (arrows). He was given IV ceftriaxone and hospitalization was arranged. Six hours after leaving the ED, house officers ordered a follow-up CXR (13 hours after the ED CXR, and 8 hours after the CT scan).

View follow-up CXR

What is the diagnosis?

Last created on 01-07-2006