Just an epigastric discomfort?

JUST AN EPIGASTRIC DISCOMFORT??


Disclaimer:This is a HIPAA de-identified open-online-patient-record with patient information posted here after collecting informed patient consent.

42 yr old male is complaining of Burning sensation in the upper abdomen since 1yr.
pt tells ''6 months back I had severe pain in right side of my upper abdomen for a week for which I was treated with medication and relieved from pain..
Now i was here because i couldn't get rid of this burning sensation in the upper abdomen which aggravates though I takes food or not.. so i take antacids frequently but of not much use. no h/o smoking or alcohol, no other addictions... also complaining of constipation and burning micturition since 3 months.. and occasional vomitings.  past history and family history are nil significant. on examination his carotid body pulsations are felt.. on suspecting hypoxia his spo2 was measured and is found to be within normal limits.(97%). His investigations are as follows:


 
chest xray was done which showed some opacities (which appeared like miliary mottling which lead to suspicion of miliary tuberculosis at one point of time.. but it was ruled out as there were no clinical symptoms suggesting it and induced sputum sample was negative for acid fast bacilli) for which CECT abdomen was done.
CECT abdomen showing massive hepatomegaly with nodularity with tongue of left lobe of liver occupying left hypochondrium. spleenomegaly can also be noted.


CECT of lungs showing Miliary mottling opacities which could be due to dilated pulmonary vessels extending till the pleura




provisional diagnosis: PORTOPULMONARY SYNDROME
the question is that how come this pt present with minimum symptoms disclosing so much after investigations?? 

Comments

  1. caregiver7careseekerMarch 6, 2019 at 8:41 AM

    👍The clinical examination findings in this man can only be shared with haptic technology but for the record the liver was palpable two cms below the right costal margin and six cms below the epigastrium (left lobe). The spleen was well palpable 3-4 cm below the left costal margin. Can his epigastric pain be explained by his liver stretching it's capsule? 🤔

    ReplyDelete
  2. SanjanaMarch 8, 2019 at 11:47 AM

    YES.. can be

    ReplyDelete

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