Kolapo DaSilva

 Name: WATKINS, KELLY S  HMC Number:  DOB: 05/18/1966  Date of Service: 12/15/2008  CHIEF COMPLAINT: Abdominal pain.  SUBJECTIVE: This is a 42-year-old, white female with a history of gastric bypass, gallbladder surgery, abdominal wall hernias, and C-sections in the past, who awoke this morning with some nausea, vomiting, diarrhea; all of which have persisted through the day. She has developed a fever with her symptoms. Late this afternoon, though, she developed severe stabbing abdominal pain on the left side. When she gets the pain, she doubles over in discomfort. She has been taking some Pepto Bismol for her symptoms and has noted that she has had some black stool with the symptoms this afternoon. She has seen no frank blood. There is no dysuria, hematuria, or urinary frequency.  MEDICATIONS: Include Zyrtec over-the-counter, hydrocodone p.r.n. pain, and Ambien p.r.n. insomnia. She has no known drug allergies.  OBJECTIVE: Patient is in obvious distress. Her temperature is 100.7, pulse is 124, respiratory rate is 16, blood pressure is 110/70. There is no CVA tenderness. The lungs are clear. Bowel sounds are diminished significantly, and there is some distention of the abdomen. There is marked tenderness with guarding and rebound in the left mid abdomen. No masses appreciated. The rectum is without mass. The stool is brown and heme-negative. Urinalysis shows a specific gravity of 1.030, pH of 5; negative dip stick otherwise.  ASSESSMENT: Severe abdominal pain, rule out adhesions, rule out obstruction, rule out diverticulitis.  PLAN: Patient is triaged to the Emergency Department for ongoing evaluation. Emergency Department has been notified of the patient transfer.

 Benign tumor with propensity for local recurrence  Slow growing, and many are followed up with serial imaging  If symptomatic, resection is a treatment  Local recurrence is very common, as well as recurrence along tract of resection/biopsy, so wide margins are necessary to reduce risk of recurrence  Visualization on imaging  US: Variable, ranging from focus of increased reflectivity in fat to lesion with same echo characteristics as surrounding fat  XRAY/CT: well defined, radiolucent mass of low attenuation (-65 to -120 HU)  MRI: Hyperintense on T1 weighted images

LATERAL RADIOGRAPH OF KNEECTS AND T1 MRI OF CALF

 Adam: Grainger & Allison's Diagnostic Radiology, 5th ed:CHAPTER 45 – Techniques and Imaging of Soft Tissues  PowerChart  IDX ImageCast