Overly Traumatic: A Teenager Elbowed in the Stomach
Case:
A 17 yo healthy M presents with abdominal pain and a syncopal episode several hours after getting elbowed in the stomach at a soccer game.
PMH: Intermittent asthma
ROS: Sore throat, cough and fatigue x 1 week.
Physical Exam:
VS: T 98.3 °F | HR 90 | BP 129/60 | RR 16 | SpO2 100%
Pale but comfortable and alert. Abdomen diffusely tender, guarding in the upper quadrants. Exam otherwise unremarkable.
FAST exam:
RUQ: Free fluid in Morrison’s pouch & at the tip of the liver
LUQ: Free fluid in splenorenal recess & bowel floating in free fluid
Transverse Bladder: Large amount of fluid & clotted blood anterior to the bladder
Click ahead to reveal diagnosis