Case study...JULY 6th

[chetnarayan]

Case study...JULY 6th



BACKGROUND
A father brings his 15-year-old son to the emergency department because of a large bruise over the son's lower left ribs from being struck by a lacrosse ball during an inter–high school game. In addition to complaining of pain in the upper portion of his left abdomen, the patient also has pain in his left shoulder, which movement seems to aggravate. He is ambulatory and in no acute distress.

The triage nurse orders a chest radiograph, which is normal. The patient is triaged to fast-track care.

On physical examination, the patient has a blood pressure of 125/78 mm Hg, a heart rate of 106 beats per minute, and a respiratory rate of 12 breaths per minute. His temperature and oxygen saturation are normal. He has no trouble walking, but he seems to have a lot of pain while positioning himself on the bed. Findings from cardiorespiratory examination are unremarkable. He has diffuse abdominal tenderness that is most pronounced in the left upper quadrant. No rebound or guarding is observed. The patient has no tenderness to palpation over the left shoulder or clavicle, and he has full range of motion in that joint.

What is the diagnosis?[/




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[unseennude]

Well!!!!
from the history and image provided, there might have been some kind of injury to the spleen!
so i think the most probable diagnose is Traumatic Splenic Injury!

[Hero]

Just looking at the "round red lesion" in the left upper quadrant I would never diagnose splenic rupture, especially when the patient is normotensive.

[JNUS]

Grade 3 splenic laceration: The injury is directly over the patient's spleen.
FAST - Focussed abdominal sonography in trauma , USG in multiple sites can give the best picture about it. But, CT abdomen would be best if patient can afford. The vital initially remains stable , but sometimes later falls so rapidly terrifying emergency / trauma management doctors.

In any Blunt abdominal trauma, your first D/D should be splenic injury, because it s what kills the patient. Angiographic embolization should be method of management or open laparotomy and total/partial splenectomy. After / before splenectomy vaccination for atypical organisms like Influenza should be taken in order to prevent OPSI ( overwhelming post splenectomy infection ).