SHM Converge Scientific Abstract ePoster Gallery-Thinking Outside the Belly: An Extra-Abdominal Mimic of Acute Pancreatitis

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This case highlights an important extra-abdominal cause of severe epigastric pain that was initially mistaken for acute pancreatitis. A 33-year-old man presented with sudden abdominal pain radiating to the back, leukocytosis, and a mildly elevated lipase. Because his symptoms and labs seemed suggestive of pancreatitis, he was admitted and treated supportively. However, abdominal CT showed only minimal nonspecific mesenteric edema and no clear pancreatic inflammation. His pain persisted after discharge and he was readmitted, but repeat abdominal CT and upper endoscopy remained unrevealing.<br /><br />The diagnosis was eventually made incidentally when a CT chest performed for transient hypoxia showed T7-T8 discitis-osteomyelitis. MRI confirmed vertebral osteomyelitis, and blood cultures grew Streptococcus viridans. After six weeks of IV antibiotics, his symptoms improved rapidly. His abdominal pain was ultimately attributed to abdominal wall pain from T7 radiculopathy caused by thoracic vertebral osteomyelitis.<br /><br />The report emphasizes that thoracic radiculopathy can present as abdominal wall pain because the abdominal wall is innervated by nerves from approximately T7 to T11. Vertebral osteomyelitis is a serious, potentially life-threatening diagnosis that is often delayed because symptoms are nonspecific. Clinicians should consider thoracic spine disease in patients with neuropathic pain, sensory changes over the abdominal wall, or abdominal pain without convincing intra-abdominal findings.<br /><br />The case also illustrates diagnostic cognitive errors, including anchoring, confirmation bias, early closure, and diagnostic momentum, which contributed to the initial misdiagnosis of pancreatitis.

Asset Subtitle

Sarah Linson

Meta Tag

Author List John Gerstenberger, Rachel Griffin, Sarah Linson

Category Clinical Vignettes

Concept Vertebral osteomyelitis

Concept Pancreatitis

Concept Acute Pancreatitis

Concept Nerve Root Disorder

Concept Diagnostic Error

Distinguished Non-Finalist

Presenter Organization University of Utah

Presenting Author Sarah Linson

Track Adult

Keywords

thoracic radiculopathy

abdominal wall pain

vertebral osteomyelitis

T7-T8 discitis

epigastric pain

acute pancreatitis misdiagnosis

Streptococcus viridans

MRI confirmation

cognitive bias

extra-abdominal cause

Vertebral osteomyelitis

Pancreatitis

Acute Pancreatitis

Nerve Root Disorder

Diagnostic Error