Image 6: A 65 year old Indian male presents with abdominal pain
Written by: Ahmed Tarig Ahmed, MD. Resident in Internal Medicine, Cook County Hospital, Chicago, IL, USA Reviewed by: Sami Elsayed, MD, Interventional and Neuroradiologist, Pittsburg, PA, USA Muhammad Elamin, MRCP(UK), DTM&H, Specialty Registrar in Infectious Diseases, Leeds, UKHistory and Physical Examination
A 65 years old Indian man arrived recently in the USA, presents with 2 weeks history of abdominal pain and 1 week of fever, chills and fatigue. He had no past history of liver disease. He had no history of diarrhea. On examination, temperature was 38.5 degrees Celsius, blood pressure of 135/70, Heart rate 120, respiratory rate 15. Pulmonary and cardiac examination revealed no abnormality.
Abdominal examination revealed epigastric and right upper quadrant tenderness, and negative Murphy’s sign, no organomegaly was elicited.
Investigations:
|
Test |
Result |
Normal range |
|
Basic metabolic panel Na, K, BUN, Cr, HCO3, Chloride |
Within normal limits |
|
|
Hemoglobin |
10.6 |
14-17 in males |
|
WBC count |
26,000 cells/micro liter Differential: Bands 15%, Neutrophils 70%, Lymphocytes 12% |
3,500-10,000 in Blacks 4,000-10,000 in non blacks |
|
Bilirubin |
2 mg/dl |
0.3-1.2 |
|
ALT |
63 U/liter |
0-35 |
|
AST |
88 U/liter |
0-35 |
|
Alkaline phosphatas |
155 U/liter |
36-92 |
|
Hepatitis B, C |
Negative |
|
|
Alpha fetoprotein |
Within normal limits |
|
|
Chest Xray |
Clear lung fields |
|
CT abdomen was performed
CT demonstrated a 9 cm hypodense lesion with internal septa causing mild dilatation of the intrahepatic duct due to extrinsic compression. No adjacent lower lobe lung findings. Gallbladder and common bile ducts were normal. Kidneys, adrenals and pancreas were normal as well.