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A challenging presentation of left upper quadrant pain
  1. R Taghizadeh1,
  2. B K Chew1,
  3. K G Mitchell2
  1. 1Canniesburn Plastic Surgery Unit, Glasgow Royal Infirmary, Glasgow, UK
  2. 2Department of General Surgery, Royal Alexandra Hospital, Paisley, UK
  1. Correspondence to:
    Dr R Taghizadeh
    Canniesburn Plastic Surgery Unit, Glasgow Royal Infirmary, Glasgow G61 1NB, UK; rieka78taghizadehyahoo.com

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Clinical presentation

A 21 year old female was admitted with a 48 hour history of severe left upper quadrant and loin pain with radiation to the shoulder tip, nausea, and vomiting. She was para 1+0 with a past medical history of a negative laparoscopy for investigation of mennorhagia seven weeks prior to admission. Physical examination revealed a pyrexia of 38.4°C and sinus tachycardia of 120 beats per minute. She had severe tenderness and guarding in the left upper quadrant and loin, in addition to left sided basal crepitations. Blood tests revealed a white cell count of 23×109/l, platelet count of 312×109/l, and C reactive protein of 300 mg/l. The remainder of her blood investigations were within the normal range.

Chest x ray revealed left basal consolidation. Abdominal ultrasound scan showed a left sided subdiaphragmatic collection associated with other abnormalities which were investigated further by subsequent computed tomography scan (fig 1).

Figure 1

 Splenomegaly (A) and extensive thrombus within the splenic vein (B).

Question

What are the abnormalities noted at A and B in fig 1? What is the diagnosis and management?

See page 1317 for answer

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Footnotes

  • Robin Spiller, editor

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