Abstract
Right upper quadrant pain is a common presenting complaint to the general and hepatobiliary surgical team. Differential diagnoses include gallstones, cholecystitis, liver and pancreatic pathology. A 64-year-old man presented to our general surgical unit with right upper quadrant pain and deranged liver function tests. He underwent ultrasonography several times as well as magnetic resonance cholangiopancreatography (MRCP) in pursuit of hepatobiliary pathology. However, it was the identification of an empyema on MRCP that led to computed tomography of the thorax and the eventual discovery of the cause of the pain: a paraspinal abscess causing T10/T11 discitis. Right upper quadrant pain and deranged liver function tests justify hepatobiliary investigation. Nevertheless, after several negative tests, the differential diagnoses should be broadened and referred pain considered.
Highlights
Right upper quadrant pain is a common presenting complaint to the general and hepatobiliary surgical team
He had deranged liver function tests his bilirubin level was within the normal range throughout (
He was relatively fit with no other medical co-morbidities, including diabetes, he was slightly overweight. He had been taking simple analgesia when required but no regular hepatotoxic medication. He had ultrasonography during this admission, which showed no hepatobiliary pathology including no evidence of gallstones
Summary
A 64-year-old man presented to a tertiary hepatobiliary surgical unit with a 3-week history of worsening right upper quadrant pain He had deranged liver function tests (alkaline phosphatase [ALP] 351iu/l, alkaline transaminase [ALT] 16iu/l) his bilirubin level was within the normal range throughout (
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