Elderly woman with abdominal pain

CLINICAL INTRODUCTION A 76-year-old woman with a history of hypertension and diabetes mellitus presented to the ED with abdominal pain for 1 week. On physical examination, the patient was found to have epigastric and bilateral costovertebral angle tenderness. Laboratory tests reported elevations of white blood cell count, creatinine and serum lipase. A chest radiograph was obtained (figure 1). Question What is the most likely diagnosis?Abdominal aortic aneurysm Hepatic abscess Pneumoperitoneum Pneumoretroperitoneum Answer: D The chest radiograph showed mottled air in the subphrenic area (figure 2). The non-contrast-enhanced CT scan, which revealed retroperitoneal gas (figure 3) extending to subphrenic region along superior recess of lesser sac, indicated the diagnosis of pneumoretroperitoneum. Pneumoretroperitoneum is defined as presence of gas within the retroperitoneal space. The gas is usually from perforated retroperitoneal hollow viscus, abscess of the retroperitoneal organs,...

Source: Emergency Medicine Journal - August 17, 2016 Category: Emergency Medicine Authors: Hsieh, C.-H., Hsu, M.-Y., Liu, C.-C. Tags: EMJ Image Challenge Source Type: research