Author: Altelisha Taylor, MD
Co Author #1: Altelisha Taylor MD, MPH
Co Author #2: Neeru Jayanthi MD
Senior Editor: Krystian Bigosinski, MD
Editor: Michael Beasley, MD, FAMSSM

Patient Presentation:
A 17 year old high-level male athlete with no past medical history came to the Emory sports clinic because of right sided abdominal pain during cross country races. Case Photo #1

History:
Abdominal pain first appeared 10 months ago during a national cross country meet when the patient felt sharp, non-radiating, right-sided abdominal pain that caused him to stop running and lingered for 2 days afterwards. Since that time, the patient has felt similar pain at the 2-mile mark of cross-country races that causes him to slow his pace (by 45 seconds per mile) and lingers afterwards. He does not feel the pain during practices as it only appears when he is running at race pace (sub 5-minute mile). He denies any bruising, swelling, or trauma to his abdomen. He also denies any itching, rashes, cough, or history of asthma. He has had no changes in appetite, bowel movements, or hydration.

Physical Exam:
General: Well-appearing, in no acute distress. Alert and oriented.
Head: Atraumatic, normocephalic.
Heart: Regular rate and rhythm. No murmurs, rubs, or gallops.
Lungs: Clear to auscultation bilaterally. No wheezes, rales, or rhonchi.
Abdominal: Soft, non-tender, non-distended. No hepatomegaly. Negative McBurney's and Murphy's sign
Neuro: No gross focal deficits.
Skin: Warm and well-perfused. No cyanosis, pallor, or erythema.
Psych: Cooperative. Appropriate affect. Non-suicidal/homicidal.
Msk: No redness, deformity, or swelling on observation of abdomen. Full active and passive ROM in the lumbar spine, hip, and shoulder. Discomfort during lateral flexion to left and right but no pain.

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