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March 2014

Complex Cystic Lesions in the Liver Causing Abdominal Pain

A 74-year-old woman was seen by her primary care physician for dull epigastric and right upper quadrant abdominal pain of 1-year duration. Routine laboratory values were within normal limits.

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Test your knowledge with previous versions of the JAMA Surgery Image of the Month Quiz.

March 2014

Enlarging Breast Mass in a 55-Year-Old Woman

A 55-year-old woman presented to the clinic with a mass in her left breast that had been enlarging over the previous 3 months. The patient denied any antecedent trauma or infection.

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February 2014

An Uncommon Surgical Disease

A woman in her 50s was hospitalized for a painful anal mass. She had a history of hypertension and depression and was receiving omeprazole and paroxetine.

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February 2014

Diffuse Ulcerated Skin Rash

A 66-year-old man presented with a skin rash on his lower limb. He has been unemployed and bedridden for the last 3 years owing to his skin disease.

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February 2014

Progressive Soft-Tissue Necrosis

A 52-year-old man with type 2 diabetes mellitus and end-stage renal disease presented with painful and progressive cutaneous necrosis of his fingers, toes, and calves and generalized muscle weakness with difficulty getting out of bed and walking.

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January 2014

Left Lower Quadrant Mass

An 88-year-old man with a history of hypertension, atrial fibrillation while receiving warfarin sodium, congestive heart failure, extended right hemicolectomy for colon cancer, and abdominal aortic aneurysm repair visited the hospital with epigastric pain of 3 days' duration.

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January 2014

Pulmonary Air Crescent Sign

A 62-year-old man was admitted to our hospital with a concern of productive cough, profuse hemoptysis, and intermittent breathlessness for about 5 months. He had a 60-year history of cigarette smoking and had stopped smoking 5 months prior to being seen.

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December 2013

Right Iliac Fossa Pain

A 32-year-old woman presented to the hospital complaining about having colicky abdominal pain for the last 2 weeks. The pain was usually generalized but sometimes radiated to the right iliac fossa.

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December 2013

Abdominal Pain and a Biliary Abnormality

A 30-year-old female immigrant from Laos was referred to our institution after admission to an outside hospital for right upper quadrant abdominal pain with associated nausea and vomiting.

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November 2013

A Well-Circumscribed, Painless Abdominal Mass

A 28-year-old woman presented with a complaint of a painless abdominal mass that had been increasing in size during the past few years. Several different physicians had evaluated the patient previously without a definitive diagnosis or treatment.

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October 2013

Right Lower Quadrant Pain

A 50-year-old man presented to the emergency department with a 4-day history of right lower quadrant pain that did not migrate during that period of time.

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September 2013

Gallbladder Disease in an Elderly Patient

An 89-year-old woman presented to her geriatrician with abdominal pain for 2 days. The pain was localized to her right abdomen, both upper and lower quadrants, with acute tenderness to palpation.

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August 2013

An Unexpected Find

A 64-year-old woman presented to the emergency department with a 1-day temperature of 38.9°C (102°F). The patient had some accompanying cough, nausea, and arthralgias but denied having dyspnea, emesis, and chest or abdominal pain.

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July 2013

An Unusual Inflammatory Hepatic Lesion

A 26-year-old man was admitted to our institution for a fever (temperature, 39°C) and abdominal pain on the right side of his hypochondrium.

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June 2013

A 50-year-old white man presented to the emergency department with a chief complaint of worsening right inguinal pain and swelling for 3 days. He denied any past medical or surgical history.

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May 2013

A 33-year-old man visited the hospital with marked abdominal distention and vomiting. His medical history included epilepsy and mild mental retardation.

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April 2013

A 62-year-old woman with a medical history of gastroesophageal reflux disease, hypothyroidism, and remote bronchial tuberculosis presented to the emergency department with acute-onset bright red blood per rectum.

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March 2013

A 21-year-old man presented to the emergency department after gunshot wound to the right shoulder.

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February 2013

A 68-year-old woman with hepatocellular carcinoma underwent a liver transplant.

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January 2013

A 67-year-old female patient was referred to our hospital because of a 1-year history of intermittent right upper quadrant pain associated with anorexia and weight loss (5 kg in 6 months).

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December 2012

A 54-year-old man with a history of chronic alcoholic pancreatitis and hepatitis presented with epigastric pain and melena, with a loss of 6 kg of body weight during the last month.

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November 2012

An 18-year-old man had a 3-month history of worsening diffuse abdominal pain irradiating to the back, abdominal distention, malaise, weight loss (10 kg), and diarrhea.

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October 2012

A 71-year-old Asian man with a history of cadaveric orthotopic liver transplant for hepatocellular carcinoma in the background of hepatitis B cirrhosis 10 years earlier presented with a 6-month history of decreased appetite, decreased energy level, and slowly increasing α1-fetoprotein level.

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September 2012

A 53-year-old woman had abdominal pain, nausea, vomiting, and obstipation for 4 days.

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August 2012

A 52-year-old man came to the clinic with occasional dysuria, urinary frequency, and nonspecific abdominal pain lasting 5 months.

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July 2012

An 88-year-old woman presented to the emergency department with a 2-day history of gradual-onset, increasing right upper quadrant pain with aggravation on movement and cough.

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June 2012

A 63-year-old man underwent splenectomy, partial wedge resection of the stomach, distal pancreatectomy, and repair of a small diaphragmatic laceration for non-Hodgkin B-cell lymphoma of the spleen.

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May 2012

A 30-year-old woman presented to our clinic with a painless, left-sided neck mass, which had slowly grown during 3 years.

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April 2012

A 76-year-old man with a 2-year history of chronic intermittent epigastric pain was afebrile and had a few episodes of nausea and vomiting.

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March 2012

A 63-year-old man with history of diabetes mellitus and liver transplantation 2 years prior to admission visited the hospital with severe abdominal pain, jaundice, and vomiting 2 days after endoscopic retrograde cholangiopancreatography for investigation of increasingly abnormal liver function test results.

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February 2012

A 71-year-old woman had a sudden onset of what she described as a "tummy ache" at 9 PM the evening prior to admission to the hospital.

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January 2012

A 64-year-old man was referred to our institution after he was found to have a retrorectal mass on a computed tomographic scan he underwent for persistent rectal pain and discomfort.

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December 2011

A 52-year-old man presented to the emergency department with a history of acute left lower quadrant pain.

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November 2011

A 56-year-old woman was referred for evaluation of a multinodular goiter.

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October 2011

A 46-year-old restrained male driver involved in a high-speed head-on collision presented with hemodynamic instability following prehospital intubation for hypoxia.

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September 2011

A 75-year-old man presented to the emergency department with 2 days of sudden-onset abdominal pain, nausea, and 1 episode of hematemesis.

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