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Image of the Month—Quiz Case

Image of the Month—Quiz Case An 83-year-old woman with a noncontributory surgical history presented with nearly 1 month of mild, intermittent right upper quadrant pain. She soon noticed a slowly growing mass in this area. She denied fever, chills, nausea, or a history of trauma. Physical examination revealed a fluctuant, palpable mass in the right upper quadrant with overlying erythema and mild tenderness to palpation (Figure, A). Laboratory values were significant for a white blood cell count of 13.4 million /μL (to convert to × 109/L, multiply by .001). Noncontrast abdominal computed tomography demonstrated a large hiatal hernia, small bilateral pleural effusions, and a right anterior abdominal wall subcutaneous lesion that was approximately 5 × 9 cm. In addition, there were multiple large gallstones within an edematous gallbladder with pericholecystic fat stranding (Figure, B). Surgical management was indicated. Figure. View LargeDownload Physical examination and computed tomography findings. A, Right upper quadrant erythema, mild tenderness to palpation, and distention overlying a protruding, fluctuant mass in the right upper quadrant. B, Computed tomography image reveals a 5 × 9-cm right anterior abdominal wall lesion. What Is the Diagnosis? A.  Necrotizing fasciitis B.  Cholecystocutaneous fistula C.  Everted xiphisternum D.  Abdominal wall endometrioma Answer http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Surgery American Medical Association

Image of the Month—Quiz Case

Abstract

An 83-year-old woman with a noncontributory surgical history presented with nearly 1 month of mild, intermittent right upper quadrant pain. She soon noticed a slowly growing mass in this area. She denied fever, chills, nausea, or a history of trauma. Physical examination revealed a fluctuant, palpable mass in the right upper quadrant with overlying erythema and mild tenderness to palpation (Figure, A). Laboratory values were significant for a white blood cell count of 13.4 million /μL (to...
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Publisher
American Medical Association
Copyright
Copyright © 2011 American Medical Association. All Rights Reserved.
ISSN
0004-0010
eISSN
1538-3644
DOI
10.1001/archsurg.2011.66-a
Publisher site
See Article on Publisher Site

Abstract

An 83-year-old woman with a noncontributory surgical history presented with nearly 1 month of mild, intermittent right upper quadrant pain. She soon noticed a slowly growing mass in this area. She denied fever, chills, nausea, or a history of trauma. Physical examination revealed a fluctuant, palpable mass in the right upper quadrant with overlying erythema and mild tenderness to palpation (Figure, A). Laboratory values were significant for a white blood cell count of 13.4 million /μL (to convert to × 109/L, multiply by .001). Noncontrast abdominal computed tomography demonstrated a large hiatal hernia, small bilateral pleural effusions, and a right anterior abdominal wall subcutaneous lesion that was approximately 5 × 9 cm. In addition, there were multiple large gallstones within an edematous gallbladder with pericholecystic fat stranding (Figure, B). Surgical management was indicated. Figure. View LargeDownload Physical examination and computed tomography findings. A, Right upper quadrant erythema, mild tenderness to palpation, and distention overlying a protruding, fluctuant mass in the right upper quadrant. B, Computed tomography image reveals a 5 × 9-cm right anterior abdominal wall lesion. What Is the Diagnosis? A.  Necrotizing fasciitis B.  Cholecystocutaneous fistula C.  Everted xiphisternum D.  Abdominal wall endometrioma Answer

Journal

Archives of SurgeryAmerican Medical Association

Published: Apr 1, 2011

Keywords: edema,computed tomography,pleural effusion,physical examination,pathologic fistula,biliary calculi,dilatation, pathologic,erythema,necrotizing fasciitis,hernia, hiatal,leukocyte count,nausea,palpation,surgical procedures, operative,wounds and injuries,fever with chills,surgical history,endometrioma,right upper quadrant pain,abdominal wall, anterior,abdominal ct,xiphoid process of sternum,gallbladder,abdominal wall,reference values

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