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Young patient with periumbilical pain
  1. Konstantinos Parperis1,2,
  2. Christina Flourou3
  1. 1 Maricopa Integrated Health System, University of Arizona College of Medicine-Phoenix, Phoenix, Arizona, USA
  2. 2 Medicine, University of Cyprus Medical School, Nicosia, Cyprus
  3. 3 Nicosia General Hospital, Leukosia, Leukosia, Cyprus
  1. Correspondence to Dr Konstantinos Parperis, Maricopa Integrated Health System, University of Arizona College of Medicine-Phoenix, Phoenix, AZ 85012, USA and University of Cyprus, Medical School, Cyprus; kparperi{at}email.arizona.edu

https://doi.org/10.1136/emermed-2019-208645

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    Clinical introduction

    A 32-year-old woman with a medical history of deep vein thrombosis (DVT) presented to the ED with a 2-day history of gradually worsening periumbilical pain. She denied fever, nausea, vomiting or diarrhoea. On examination the patient was found to have dilated veins on the anterior thoracic and abdominal wall with tenderness on periumbilical area (figure 1). Murphy’s sign and McBurney’s sign were negative. No ascites was detected. Complete blood count, liver and renal function tests, lipase and urinalysis were all in the normal reference range. CXR showed dilation of upper mediastinum.

    Figure 1

    On inspection the patient had dilated veins on the …

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    Footnotes

    • Contributors With the submission of this manuscript I would like to undertake that: All authors of this manuscript have read and approved the final version submitted. All authors of this manuscript were involved in managing the patient, collecting data and writing parts for the final version. The contents of this manuscript have not been copyrighted or published previously. The contents of this manuscript are not now under consideration for publication elsewhere. The contents of this manuscript will not be copyrighted, submitted, or published elsewhere, while acceptance by the Journal is under consideration. There are no directly related manuscripts or abstracts, published or unpublished, by any authors of this paper. I confirm that all of the authors participated in the preparation of the manuscript

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; internally peer reviewed.

    • Patient consent for publication Obtained.