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Figure it out fridays 

#69

13089_2014_Article_110_Fig2_HTML.webp

 6-year-old male presented to the emergency department (ED) with sudden onset, 10/10, constant, sharp, non-radiating right lower quadrant abdominal pain of 4 h in duration. According to his mother, he had no nausea, vomiting, fever, or chills. His last normal bowel movement was 1 day prior, and he denied any urinary complaints. There was no history of rash, sick contacts, or recent travel.

 Physical Examination :

The patient was a well-developed, young male in moderate distress.

Blood pressure of 107/66 mm Hg,

Pulse of 110 beats per minute

Respiratory rate of 24 breaths per minute

Temperature of 96.9°F,

Oxygen saturation of 95% on room air.

His skin was dry and warm to palpation. The oropharynx was erythematous, with no tonsillar enlargement or exudates. The patient was tachycardic, but no murmurs, rubs, or gallops were auscultated.

His abdomen was soft and non-distended, tender to palpation in the right lower quadrant with rebound and guarding; normal active bowel sounds were present.

There was no costovertebral angle tenderness present. Rectal exam was normal with hemoccult-negative brown stool. The genitourinary exam was also unremarkable. The remainder of the physical exam was non-contributory

 

Laboratory results :

Potassium  3.3 mmol/L

Bicarbonate level  17 mmol/L.

White blood cell count 7 K/μL.

The urinalysis was positive only for trace ketones and few bacteria.

A point-of-care ultrasound was performed , and shown above.

What is your diagnosis?

A. Acute appendicitis

B. Diverticulitis

C. Abscess

D. Intussusception

E. Tumor

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