Case: 40 YO Man with McBurney Point Tenderness

AJR authors: Avielle Siegel, Paul J. Chang, David M. Paushter, Carla B. Harmath, and Abraham Dachman (Department of Radiology, University of Chicago); Zachary J. Jarou and J. Ben Arevalo (Emergency Department, University of Chicago)

History

A 40-year-old man presented with 1 week of fevers, chills, nausea, vomiting, diarrhea, and intermittent abdominal pain but no specific upper or lower respiratory symptoms aside from mild shortness of breath. The clinical examination was notable for right lower quadrant tenderness at the McBurney point.

Imaging Findings

Image via AJR article “Lung Base Findings of Coronavirus Disease (COVID-19) on Abdominal CT in Patients With Predominant Gastrointestinal Symptoms”

The chest radiograph showed normal findings. CT of the abdomen showed findings of peripheral nodular ground-glass opacities in the lung bases. Abdominal imaging findings showed a left renal mass with fluid attenuation; fluid-filled stomach; normal findings in the vasculature, gastrointestinal tract, and mesentery without wall thickening or distention; and no lymph-adenopathy or ascites.

Correct Answer: Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2)

CT of the chest and SARS-CoV-2 polymerase chain reaction testing were subsequently performed and confirmed the diagnosis. The patient was admitted to the hospital with a primary diagnosis of intractable nausea and vomiting thought to be secondary to a viral process. The patient recovered with supportive care and was discharged home 3 days later.

Suggested Readings

Learn more by reading the open-access article "Lung Base Findings of Coronavirus Disease (COVID-19) on Abdominal CT in Patients With Predominant Gastrointestinal Symptoms," as well as “Unexpected Findings of Coronavirus Disease (COVID-19) at the Lung Bases on Abdominopelvic CT.” Please find additional open-access resources on our COVID-19 microsite.