1
|
Atalay RT, Kolawole O, Ayele GM, Gobezie AA, Kibreab A, Michael MB. Right Upper Quadrant Pain: A Rare Presentation of Diverticulitis. Cureus 2024; 16:e55674. [PMID: 38586678 PMCID: PMC10997493 DOI: 10.7759/cureus.55674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Accepted: 03/06/2024] [Indexed: 04/09/2024] Open
Abstract
Acute diverticulitis is a prevalent medical condition with increasing incidence rates. While the sigmoid colon is the most commonly affected part of the large intestine, there have been occurrences of right-sided diverticulitis although uncommon. We present a case report highlighting the atypical presentation of diverticulitis in a 27-year-old female patient. The patient experienced right upper and epigastric pain and was ultimately diagnosed with right-sided diverticulitis, supported by her CT imaging findings. This uncommon presentation underscores the importance of considering diverse clinical manifestations when diagnosing and managing diverticulitis.
Collapse
Affiliation(s)
| | | | - Girma M Ayele
- Internal Medicine, Howard University Hospital, Washington DC, USA
| | - Abay A Gobezie
- Internal Medicine, Howard University Hospital, Washington DC, USA
| | - Angesom Kibreab
- Gastroenterology, Howard University Hospital, Washington DC, USA
| | - Miriam B Michael
- Internal Medicine, Howard University Hospital, Washingon DC, USA
- Internal Medicine, University of Maryland, Baltimore, USA
| |
Collapse
|
2
|
Kancheva M, Neychev V. Synchronous Acute Appendicitis and Acute Cholecystitis: A Case Report. Cureus 2023; 15:e40411. [PMID: 37456457 PMCID: PMC10348392 DOI: 10.7759/cureus.40411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 06/12/2023] [Indexed: 07/18/2023] Open
Abstract
Acute cholecystitis (AC) and acute appendicitis (AA), independently, are among the most commonly diagnosed conditions in the emergency department (ED). However, their synchronous presentation is very rare. Here, we present a 31-year-old man with worsening right flank abdominal pain, nausea, and vomiting. Physical examination results were significant for moderate to severe right upper abdominal quadrant pain with a positive Murphy's sign and right lower quadrant pain with rebound. Workup in the ED revealed leukocytosis with a left shift, and the abdominal ultrasound and computerized tomography scan showed AA and AC. A literature review revealed a paucity of publications on concomitant AA and AC. Reporting new cases will contribute to improving our understanding of the biology, natural history, and management of this rare pathological combination.
Collapse
Affiliation(s)
- Mihaela Kancheva
- Surgery, University of Central Florida College of Medicine, Orlando, USA
| | - Vladimir Neychev
- Surgery, University of Central Florida College of Medicine, Orlando, USA
| |
Collapse
|
3
|
Sharma R, Stead TS, Aleksandrovskiy I, Amatea J, Ganti L. Gallbladder Hydrops. Cureus 2021; 13:e18159. [PMID: 34703693 PMCID: PMC8530502 DOI: 10.7759/cureus.18159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/21/2021] [Indexed: 11/05/2022] Open
Abstract
The authors describe the case of a middle-aged female who presented to the emergency department with exquisite right upper quadrant pain. Computed tomography scan of the abdomen revealed a hydropic gallbladder, confirmed with abdominal ultrasonography. The clinical presentation, imaging findings, and management of this interesting condition are discussed.
Collapse
Affiliation(s)
- Rhea Sharma
- Emergency Medicine, Chantilly High School, Chantilly, USA
| | - Thor S Stead
- Medicine, The Warren Alpert Medical School of Brown University, Providence, USA
| | | | - John Amatea
- Emergency Medicine, Lakeland Regional Health, Lakeland, USA
| | - Latha Ganti
- Emergency Medicine, Envision Physician Services, Plantation, USA.,Emergency Medicine, University of Central Florida College of Medicine, Orlando, USA.,Emergency Medicine, Ocala Regional Medical Center, Ocala, USA.,Emergency Medicine, HCA Healthcare, Orlando, USA
| |
Collapse
|
4
|
Padilla RM, Way AR, Soule E, Gopireddy D, Lall C. Diffusion Weighted Imaging in Unilateral Adrenal Infarction: A Case of Colicky Right Upper Quadrant Pain in a Pregnant Female. Cureus 2021; 13:e13289. [PMID: 33728222 PMCID: PMC7949625 DOI: 10.7759/cureus.13289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/11/2021] [Indexed: 11/08/2022] Open
Abstract
Diffusion weighted imaging (DWI) is a magnetic resonance imaging (MRI) non-contrast sequence that can indicate tissue ischemia or infarction. Adrenal infarct may present similarly to biliary or gallbladder pathologies, and the differential diagnosis during emergency work-up can be narrowed utilizing DWI sequences. In this paper, we describe the usefulness of DWI for urgent diagnosis in a case of non-hemorrhagic adrenal infarct of a pregnant female presenting with right upper quadrant pain. Although uncommon, adrenal infarct may occur in patients with hypercoagulability and localizing pain that is unexplained by other imaging modalities. We outline the imaging features of DWI in evaluating adrenal infarct as a safe and time effective application for patients with contraindications to imaging with ionizing radiation.
Collapse
Affiliation(s)
- Rebekah M Padilla
- Diagnostic Radiology, University of Florida College of Medicine, Jacksonville, USA
| | - Ashley R Way
- Radiology, University of Florida College of Medicine, Jacksonville, USA
| | - Erik Soule
- Interventional Radiology, University of Florida College of Medicine, Jacksonville, USA
| | - Dheeraj Gopireddy
- Radiology, University of Florida College of Medicine, Jacksonville, USA
| | - Chandana Lall
- Abdominal Imaging, University of Florida College of Medicine, Jacksonville, USA
| |
Collapse
|
5
|
Hiatt KD, Ou JJ, Childs DD. Role of Ultrasound and CT in the Workup of Right Upper Quadrant Pain in Adults in the Emergency Department: A Retrospective Review of More Than 2800 Cases. AJR Am J Roentgenol 2020; 214:1305-10. [PMID: 32160055 DOI: 10.2214/AJR.19.22188] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVE. The purpose of this study was to compare ultrasound and CT in the diagnostic evaluation of right upper quadrant pain in adults in the emergency department. MATERIALS AND METHODS. A retrospective review was conducted of adult emergency department encounters for right upper quadrant pain over a 5-year period, excluding those for prior cholecystectomy, current pregnancy, and trauma. Imaging study reports were reviewed for gallbladder and nongallbladder explanations of right upper quadrant pain and were considered positive for cholecystitis when two or more supportive features were present. Encounter outcomes were evaluated on the basis of pathology data and clinical management. RESULTS. Among the encounters, 2859 met the study inclusion criteria, and 18% met the study definition of cholecystitis by pathologic or clinical criteria. The following metrics showed no statistically significant difference between ultrasound and CT, respectively: sensitivity, 61% and 55%; specificity, 91% and 92%; positive predictive value, 63% and 63%; and negative predictive value, 91% and 90%. Both modalities were performed in 20% of encounters. In the subgroup analysis, ultrasound showed an acute nongallbladder abnormality that was missed at a preceding CT examination in only 1 of 238 cases (0.4%). CT showed an acute nongallbladder abnormality missed at a preceding ultrasound examination in 103 of 322 cases (32%). CONCLUSION. CT is noninferior to ultrasound in both ruling in and ruling out the diagnosis of cholecystitis in adult patients undergoing emergency evaluation of right upper quadrant pain and offers the advantage of depicting acute nongallbladder abnormalities.
Collapse
|
6
|
Abstract
We present a rare case of giant adrenal pseudocyst as a cause of right upper quadrant (RUQ) pain and highlight the typical multimodality imaging features. The case demonstrates the imaging features associated with giant adrenal pseudocysts to aid accurate and timely diagnosis. Despite the rarity of these lesions they are important to consider as benign lesions can closely mimic malignant ones. Unenhanced and contrast-enhanced CT is the imaging of choice for adrenal cysts. However, MRI can provide more exquisite assessment of cystic, solid and enhancing components. Pseudocysts can be purely cystic, mixed or solid. Classically, adrenal pseudocysts are described as cystic lesions (of homogenous water density) with a fibrous wall and thin internal septations. Mural/septal calcification is commonly demonstrated due to haemorrhage, this is discernible from central/amorphous calcification seen in malignant disease. As in this case, pseudocysts can contain solid components or layering secondary to haemorrhage. The key to differentiating organised haematoma from tumour is the lack of enhancement. If serial imaging is undertaken in these patients rapid changes in the solid components may be seen reflecting resolving haematoma. Adrenal pseudocysts are rare and have a wide differential. Cystic adrenal lesions warrant multimodality assessment as their imaging features aid diagnosis and differentiation from malignant disease. We suggest that MRI plays a complimentary role to CT. CT is superior at demonstrating mural/septal calcification but MRI aids in determining cystic components and differentiating haemorrhage from tumour.
Collapse
Affiliation(s)
- Isabel Haines
- Department of Radiology, University Hospital Bristol, Bristol, UK
| | | |
Collapse
|
7
|
Revzin MV, Scoutt LM, Garner JG, Moore CL. Right Upper Quadrant Pain: Ultrasound First! J Ultrasound Med 2017; 36:1975-1985. [PMID: 28586152 DOI: 10.1002/jum.14274] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/26/2016] [Accepted: 01/27/2017] [Indexed: 06/07/2023]
Abstract
Acute right upper quadrant (RUQ) pain is a common presenting symptom in emergency departments and outpatient medical practices, and is most commonly attributable to biliary and hepatic pathology. Ultrasound should be used as a first-line imaging modality for the diagnosis of gallstones and cholecystitis, as it allows the differentiation of medical and surgical causes of upper abdominal pathology, and in many circumstances is sufficient to guide patient management. Knowledge of strengths and limitations of ultrasound in the evaluation of RUQ is paramount in correct diagnosis. A spectrum of RUQ pathology for which a RUQ ultrasound examination should reasonably be considered as the initial imaging modality of choice will be reviewed.
Collapse
Affiliation(s)
- Margarita V Revzin
- Department of Diagnostic Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Leslie M Scoutt
- Department of Diagnostic Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Joseph G Garner
- Department of Medicine and Infectious Diseases, Hospital of Central Connecticut, New Britain, Connecticut, USA
| | - Christopher L Moore
- Department of Emergency Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
| |
Collapse
|
8
|
Chen TH, Tseng YH, Tseng CM, Chiang HH, Lin TJ. Spontaneous hemopneumothorax simulating acute abdominal affections. Pediatr Pulmonol 2014; 49:E1-4. [PMID: 23169600 DOI: 10.1002/ppul.22712] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2012] [Accepted: 10/02/2012] [Indexed: 11/06/2022]
Abstract
Spontaneous hemopneumothorax (SHP) is a rare potentially life-threatening condition that occurs in predominantly young adolescents. The resultant massive hemorrhage leading to hypovolemic shock can be a surgical emergency. It constitutes 1-12% of all spontaneous pneumothoraces and presents with two cardinal features, chest pain and dyspnea. However, the pain of SHP may be confined to the abdomen secondary to the irritation of diaphragmatic pleura, which produces signs simulating an acute abdomen. SHP masquerading as an abdominal affection is apparently regarded as extremely rare. We present a case of a 16-year-old male with SHP presenting features simulating acute gallbladder disease. After prompt diagnosis with appropriate surgical intervention, he had an uneventful recovery. Our experience emphasizes the importance of careful and thorough chest examination for each child with atypical pictures for abdominal pain to exclude possible extra-abdominal lesions, even rare as SHP.
Collapse
Affiliation(s)
- Tai-Heng Chen
- Department of Pediatrics, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; Division of Pediatric Emergency, Department of Emergency, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | | | | | | | | |
Collapse
|