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A 35-Year-Old Woman With Progressively Worsening Abdominal Pain and Shortness of Breath
Ronald N. Rubin, MD1,2 —Series Editor
1Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania
2Department of Medicine, Temple University Hospital, Philadelphia, Pennsylvania
Rubin RN. A 35-year-old woman with progressively worsening abdominal pain and shortness of breath. Consultant. 2021;61(10):e21-e23. doi:10.25270/con.2021.10.00005
The author reports no relevant financial relationships.
Ronald N. Rubin, MD, Temple University Hospital, 3401 N Broad Street, Philadelphia, PA 19140 (email@example.com)
A 35-year-old woman called her primary care provider about a week’s duration of upper abdominal pain and ongoing shortness of breath, most noticeable with exertion. The abdominal pain had started by awakening her from sleep 5 days ago and has been essentially constant since. It is characterized as sharp and most marked in the upper abdomen below her ribs bilaterally. This pain is not relieved by bowel movements, eating, or antacids. There is some nausea and vomiting associated with the pain. The shortness of breath had onset at essentially the same time and is most noticed when the patient exerts herself, such as when she performs her usual fitness routine or walks quickly. There is no cough, purulent sputum, or hemoptysis.
The patient is a previously healthy woman who is an office manager and does not smoke or consume excess alcohol. She takes vitamins, but her only other medicine exposure is a low-estrogen oral contraceptive. She received a COVID-19 vaccination 2 weeks prior to presentation and did not have any adverse effects.
Results of a physical examination revealed a normal temperature, a high pulse rate of 100 beats/min, a low blood pressure of 115/70 mm Hg, and high respiration rate of 16 breaths/min. An examination of her head, eyes, ears, nose, and throat showed unremarkable results. Results of a chest examination showed decreased breath sounds and fine rales of the left base. Her heart had regular rhythm without obvious murmur or rub. Her abdomen was tender in the upper quadrants. Bowel sounds were present but diminished, and there was no rebound. There was the impression that the most tender area was the left upper quadrant.
A plain-film chest radiography scan did not show infiltrates, and an office portable Doppler did not reveal lung infiltrates, effusion, or pneumothorax.
Results from initial laboratory studies showed a completely normal basic metabolic and comprehensive metabolic panel. Results of a complete blood cell count showed a normal hemoglobin level of 13.2 g/dL, an elevated white blood cell count of 14.1/μL with a slight left shift and platelets of 68 × 103/μL. Her arterial oxygen saturation was 93 mm Hg, but there was a gradient of 14 mm.
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