Case of the Month September 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 Catherine Evans, MD, and  Thomas J. Learch, MD

Clinical History

A 10 year-old girl with no significant past medical history presented as a transfer from OSH with 4 day history of severe lower abdominal pain, nausea and vomiting. Patient reported associated symptoms of dysuria, red-tinged hematuriax 3 days and diarrhea x 2 days. Mother at bedside also reported subjective fevers and decreased appetite. Patient had not begun menstruation. Of note, patient’s mother began menstruation at age 11.

Physical Exam
  • General:  Ill-appearing, Diaphoretic. 
  • HEENT:  Anicteric, Normocephalic. 
  • Cardiovascular:  Tachycardic, No murmur. 
  • Chest:  Respirations are non-labored, Symmetric. 
  • Abdomen:  Soft, Non-distended.  Diffusely tender, worst suprapubic/bilateral lower quadrants. 
  • GU - Female:  Normal external genitalia.
  • Extremities:  Warm, Well perfused, Moves all extremities. 
  • Neurologic:  No focal neurological deficit observed, Developmentally normal.
Abnormal Labs 

  • WBC 21.6
  • T bili 1.6
  • AST/ALT 69/84
Vitals
  • Temperature 37.8 C
  • Respiratory rate 28 breaths/min
  • Heart rate 130 bpm
  • Blood pressure 119/77
Ultrasound

Abdominal ultrasound and contrast-enhanced CT abdomen/pelvis was performed at the outside hospital. What are the findings?

 

 

 

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