Case of the Month: April, 2011

Submitted by Blake Kightlinger, MD and Mamata Chithriki, MD.

History: 8 year old previously healthy girl presented to emergency room after awakening with acute worsening of right lower quadrant abdominal pain. Patient had fallen two weeks prior and only had mild right sided abdominal pain associated with bruising. She denied nausea, vomiting, dysuria, or hematuria. Physical exam is remarkable for mild tenderness to deep palpation in right lower quadrant, no rebound or guarding. Vital signs demonstrated a BP = 136/84 and HR = 109. Initial labs showed WBC = 11K, H/H = 12/35, Plt = 333K and Bun/Cr = 6/0.5. Urinalysis was negative for WBC and RBC. CT scan with oral and rectal contrast was ordered to primarily investigate for appendicitis.

Question: Can you identify the organ with the abnormality?

  1. Large bowel
  2. Kidney
  3. Pancreas
  4. Gallbladder
  5. Appendix

CT of the Abdomen ( Click here for larger image. )

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