The Case Files: Right Flank Pain and Nausea

Bremjit, Prasheeda MD; Sheele, Johnathan M. MD, MPH A 27-year-old woman with a history of recurrent urinary tract infections presented to the emergency department with right-sided flank pain and nausea. She denied fevers, chills, urinary symptoms, diarrhea, and constipation, though she did report some mild dyspnea and cough. She reported that she had had a normal spontaneous vaginal delivery of a healthy infant two weeks earlier. Pregnancy was complicated only by a urinary tract infection.   The patient was febrile to 38.6°C. She did not have right costovertebral tenderness or right upper quadrant abdominal pain. Urinalysis was notable for positive nitrite, small leukocyte esterase, 5–10 white blood cells, 3–5 red blood cells, and positive bacteria. The urine culture ultimately grew 20,000 organisms of more than two organisms thought to be related to skin contamination. Serum laboratory testing was significant for a white blood cell count of 21,000 cells/μL, alkaline phosphatase 205 U/mL, total bilirubin 0.8 mg/dL, AST 37 U/L, and ALT 24 U/mL. The patient was given intravenous ceftriaxone in the ED for presumed pyelonephritis. One hour into her ED stay, she was noted to have tachypnea. Chest x-ray was obtained, and read as “probable mild blunting right costophrenic angle, perhaps atelectasis or small effusion. Fluid level right upper quadrant, likely within a loop of bowel or stomach.”   A computed tomography scan of the chest, abdomen, and pelvis revealed several...
Source: The Case Files - Category: Emergency Medicine Tags: Blog Posts Source Type: research