title: Right upper quadrant pain and raised alkaline phosphatase is not always a hepatobiliary problem.
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.
authors.affiliation: University Hospitals of Leicester NHS Trust, UK.
authors.forename: G
authors.initials: G
authors.lastname: Cheyne
authors.affiliation: franscois_gerald@yahoo.com.
authors.forename: F
authors.initials: F
authors.lastname: Runau
authors.forename: D M
authors.initials: DM
authors.lastname: Lloyd
mesh_terms: D015746:Abdominal Pain / Q000209:etiology*; D000038:Abscess / Q000175:diagnosis*; D000469:Alkaline Phosphatase / Q000378:metabolism*; D001649:Bile Duct Diseases / Q000175:diagnosis*; D049448:Cholangiopancreatography, Magnetic Resonance; D003937:Diagnosis, Differential; D004653:Empyema / Q000175:diagnosis / Q000209:etiology; D006801:Humans; D008111:Liver Function Tests; D008297:Male; D008875:Middle Aged; D013122:Spinal Diseases / Q000175:diagnosis*
chemical_list: D000469:Alkaline Phosphatase