DrVirgo
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A 36 year old man comes the the ED because of a 20 hour history of worsening right lower quadrant pain. One week ago he was treated with cephalexin for furnunculosis. He has had type I DM for 10 years and is on insulin. HIs temp is 101.9F, axillary and 100.6 rectally. Exam shows multiple furuncles on the inner side of both thighs, most of them are in regression. Exam shows tenderness on deep palpation in the RLQ without rebound or guarding. No masses are palpated. Psoas sign in positive. Bowel sounds are present. Rectal exam shows no abnormalities.
Lab studies:
RBC: 4.1 million/microL
WBC: 14,500/microL
ESR: 24 mm/h
Glucose: 90mg/dL
BUN: 9 mg/dL
UA Protein (-) WBC: 2/HPF
Which of the following is the next appropriate next step in management?
A. Appendectomy
B. Laproscopy
C. CT of the abdomen
D. Colonoscopy
E. AP and Lateral lumbar films
What's the most likely diagnosis?
Does he have appendicitis? If so what makes you think that he does? And if not, waht made you rule it out?
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| robin082006
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E. AP and Lateral lumbar films
paraspinal abscess?
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| Aashi
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An obvious focus of infection--->now c/o of RLQ pain mimicking appendicits--->psoas sign positive--->think of an abcess--->abcess is best seen with an U/S or a CT--->No U/S as an option---->so do an abd CT------->C
Edited by Aashi on 03/23/07 - 06:14 PM
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| new_n_lost
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E. AP and Lateral lumbar films
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| DrVirgo
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It IS Psoas Abscess, but the answer is C -CT of Abdomen...
the patient probably has psoas abscess resulting from hematogenous spread of bacteria. There is no guarding, rigidity, rebound tenderness in teh RLW so therefore it can't be appendicitis.
Psoas sign requires a CT for diagnosis. If clinical suspicion of psoas abscess is high and CT is negative, laparoscopy is indicated. Patients with psoas abscess are treated with drainage adn systemic antibiotics.
Colonoscopy and AP lateral lumbar films are not useful in the above patient.
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| Aashi
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Yep for an abcess its ether an U/S or CT--->made a typo in my answer,xrays are useless when ur suspecting an abcess..
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| Justice
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This is a psoas abscess and the answer is (C)
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| ashfaque
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C nicely explained by Aashi
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| Tuscani
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nice aashi!!
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