Case of the Month March 2017

Our Imaging Case of the Month is presented as a part of the Imaging Department's residency teaching program. Each month a resident collaborates with one of our attending imaging physicians to present an interesting case to the Cedars-Sinai medical community. The case is used to teach both imaging and other residents at Cedars-Sinai. Below is the current Case of the Month.

Submitted by Sardius Chen, MD, and  Thomas J. Learch, MD

  • This is a 42-year-old patient with four-day history of intermittent cramping abdominal pain for the past few months, which acutely worsened on six days prior to admission in the lower abdomen to a sharp and constant quality.
  • She also has loose stools with blood clots (denies previous episodes) and bilious vomiting.
  • The patient has never had a colonoscopy and denies aspirin or NSAID use.
  • She had one previous admission one week prior to this presentation at another hospital where she was treated empirically for colitis with antibiotics and discharged with follow-up for suspected inflammatory bowel disease.
  • Patient denies fevers or rashes.
  • The patient reports family history of ulcerative colitis.
  • Additional prior GI workup includes an endoscopy in 2011 for vomiting, which showed mild esophagitis on biopsy.
  • She was started on a proton pump inhibitor with symptomatic improvement.
Medical and Surgical History
  • Adenomyosis s/p TAH
  • Hypertension
  • Cholecystectomy
  • Carpal tunnel release
  • Lipoma resection
Physical Exam/Labs
  • One week prior: initial vitals with no fever, HR <90. WBC 18, Hgb 13.6. CRP 0.92.
  • This presentation: afebrile, HR 64, BP 146/94, RR 18, SpO2 98 % RA  
  • General: alert, cooperative, no distress, appears stated age.
  • Pulmonary: clear to auscultation bilaterally.   
  • Heart: normal rate and regular rhythm, S1, S2 normal, no murmur.
  • Abdomen: soft, distended. Minimal tenderness in upper quadrants with deep palpation without rebound or guarding. Minimal bowel sounds throughout.
  • Extremities: extremities normal, atraumatic, no cyanosis or edema.
  • WBC 12.4 Hgb 12.2, Hct 34.8, Plt 306/ CRP 11.7/ K 3.3, Cr 0.5, Alb 3.4; otherwise Chem 14 WNL
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