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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.
The bruise is shown above. What is the diagnosis? |
Hint
The location of the injury is the key
feature. |
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Authors:
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D. Brady Pregerson, MD,
Attending Physician,
Department of Emergency
Medicine,
Cedars Sinai Medical Center;
Author,
Quick Essentials: Emergency Medicine and
Pharm Animals Pharmacopoeia
(www.ERpocketbooks.com)
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eMedicine
Editor:
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Eugene Lin, MD,
Department of Radiology,
Virginia Mason Medical Center,
Seattle, WA,
Assistant Clinical Professor of Radiology University of
Washington Medical Center,
Seattle, WA
Rick G. Kulkarni, MD,
Assistant Professor,
Yale School of Medicine,
Section of Emergency
Medicine,
Department of Surgery,
Attending Physician,
Medical Director,
Department of Emergency
Services,
Yale-New Haven Hospital |
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