History of Present Illness:
A 22-year-old female presents to the ED for a year of intermittent left rib and left upper quadrant pain with no other associated symptoms. She never saw a doctor for it but it has been worse over the past 2 weeks than it ever was before. The pain is not pleuritic nor exertional and has no triggers. There is no associated vomiting, diarrhea, fever, dysuria, discharge, shortness of breath or other complaints.
Vital Signs & Physical Exam:
Vital signs are normal. Physical exam is otherwise normal except for left anterior rib area tenderness and maybe some slight LUQ tenderness. There is no rash nor other exam findings
Initial Diagnostic Testing:
- Labs: CBC, BMP, LFT, D-dimer, HCG all normal
- Imaging: see below
What is the most likely diagnosis?
- A) Pyelonephritis
- B) Gastritis
- C) Kidney stone
- D) Splenomegaly
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What is the most likely diagnosis?
- A) Pyelonephritis
- B) Gastritis
- C) Kidney stone
- D) Splenomegaly – CORRECT – he image shows mild splenomegaly. Normal is <12cm in longest dimension with 12-14cm being borderline enlarged and >14cm definitely enlarged.
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CASE CONCLUSION: Patient was referred to hematology for a work up of the cause.