The Daily PANCE and PANRE Extended Edition: Question 23

An 82-year-old man presents with acute, atraumatic left flank pain which is constant. He denies fever. Since its onset, the pain has moved from the flank to the central abdomen and also radiates into the left inguinal area. Of the following, which diagnosis do you suspect?

  1. acute bacterial prostatitis
  2. Spigelian hernia
  3. calyceal obstruction
  4. acute biliary colic
  5. dissecting aortic aneurysm

Answer: E

Dissecting aortic aneurysm

This pain is constant pain, so not colicky (like colic C and D). It is in the abdomen and not perineal (like BPH) and I have no idea what a Spigelian hernia is, but in this older gentleman, the most important things to R/O is AAA which is dissecting.

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