eMedicine Image Case 14

[Jon Adler, MD]

Title: eMedicine

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Delayed Presentation of Abdominal Pain

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BACKGROUND This middle-aged patient was working under his car when his abdomen became pinned under the car for a brief moment. Although the patient is unclear about the mechanism, he states that the car jack that he used to raise his car never gave way. The patient had presented to the hospital 2 days prior but left against medical advice after a chest radiograph was obtained. He returns today complaining of a tender abdomen, but he has no other complaints on the review of systems. What is the differential diagnosis? What is the most likely diagnosis? What test should be ordered next? Hint His vital signs are stable, and his pulse oximetry reading is 99%. The chest radiograph obtained 2 days ago shows mild cardiomegaly but no pneumothorax or rib fractures. Author: John Leung, MD, Yale University- Yale New Haven Hospital eMedicine Editor: Carl Boyer, MD
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