• Heart Failure
  • Cardiovascular Clinical Consult
  • Adult Immunization
  • Hepatic Disease
  • Rare Disorders
  • Pediatric Immunization
  • Implementing The Topcon Ocular Telehealth Platform
  • Weight Management
  • Monkeypox
  • Guidelines
  • Men's Health
  • Psychiatry
  • Allergy
  • Nutrition
  • Women's Health
  • Cardiology
  • Substance Use
  • Pediatrics
  • Kidney Disease
  • Genetics
  • Complimentary & Alternative Medicine
  • Dermatology
  • Endocrinology
  • Oral Medicine
  • Otorhinolaryngologic Diseases
  • Pain
  • Gastrointestinal Disorders
  • Geriatrics
  • Infection
  • Musculoskeletal Disorders
  • Obesity
  • Rheumatology
  • Technology
  • Cancer
  • Nephrology
  • Anemia
  • Neurology
  • Pulmonology

A 46-year-old Man with Right-sided Abdominal Pain, Slight Fever


The patient says the pain is worse with movement or coughing. He reports no nausea, vomiting, fever, diarrhea, or other complaints. What's your diagnosis?

Abdominal CT

History. A 46-year-old man with no significant past medical history presents to the emergency department for 3 days of slowly progressive, constant, right-sided abdominal pain. He notes that the pain is worse with movement or coughing. He reports no nausea, vomiting fever, diarrhea, or other complaints.

Examination. Vital signs are normal except for a temperature of 99.2°F and respirations at 22 per minute. The abdomen is soft. The area of maximal pain indicated by the patient is also the area of maximal tenderness and is located midway between McBurney's and Murphy's points. There is no guarding or rebound. He also has mild right-sided costovertebral angle tenderness.

Initial Concerns: gallstone, kidney stone, appendicitis


  • WBC = 9.2 with 74% PMNs
  • AST/ALT = 83/70 U/L
  • UA negative
  • CT image at right


  1. What does the case image show?
  2. What should you do next?

Related Videos
Related Content
© 2024 MJH Life Sciences

All rights reserved.