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JAMA Clinical Challenge
June 10, 2019

A Patient With Abnormal Abdominal CT Scan Findings

Author Affiliations
  • 1Department of Surgery, Jesse Brown Veterans Administration and Medical Center, Chicago, Illinois
  • 2Case Western Reserve School of Medicine, Cleveland, Ohio
  • 3Department of Radiology, Jesse Brown Veterans Administration and Medical Center, Chicago, Illinois
JAMA. Published online June 10, 2019. doi:10.1001/jama.2019.6849

A 51-year-old man with a history of hypertension, hypercholesterolemia, and nephrolithiasis presented to the emergency department with left flank and left upper quadrant abdominal pain. He stated that “I think I have a kidney stone blocking my kidney” but denied nausea, vomiting, fever, dysuria, hematuria, or weight loss. He had no history of chronic abdominal pain. Past surgical history was noteworthy for emergency exploratory laparotomy and splenectomy for blunt trauma 14 years prior. Physical examination revealed a comfortable-appearing patient in no acute distress. His temperature was 36.8°C; pulse, 77/min; and blood pressure, 125/86 mm Hg. Abdominal palpation elicited only mild epigastric tenderness without masses or rebound. There was no costovertebral angle tenderness.

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