patient 22 year old Male Lean thin whole abdomen ultrasonography pain in Left hypochondriac region
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left hypochondriac region pain normal ultrasound young male causes differential diagnosis
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I now have all the information needed to provide a comprehensive interpretation. Here is the full clinical analysis:
Ultrasound Report Interpretation — 21-year-old Male, Left Hypochondriac Pain
Report Summary (Gazi Medical College Hospital, Dr. Bithi Ghosh, 5-May-2026)
| Organ | Finding |
|---|---|
| Liver | Normal — 141 mm, homogeneous echotexture, no focal lesion |
| Gallbladder | Normal — no calculus/sludge |
| Biliary tract | Normal |
| Pancreas | Normal — MPD normal |
| Spleen | Normal — 106 mm |
| Right Kidney | Normal — 104×49 mm, no hydronephrosis/stone |
| Left Kidney | Normal — 108×52 mm, no hydronephrosis/stone |
| Ureters | Normal bilaterally |
| Urinary Bladder | Normal — no intravesical lesion |
| Prostate | Normal |
| Overall Comment | Normal Study |
What the Ultrasound Images Show
The scan images include:
- Top-left: Gallbladder measurements (DT 2.43 cm, D2 3.81 cm; D3 2.78 cm, Volume ~15.51 ml) — normal
- Top-right: A large structure with a measurement of 14.19 cm — this appears to be the spleen in a different plane or the left kidney (the written report calls the spleen 106 mm, which is within normal limits ≤12 cm)
- Middle row: A structure measured ~10.67 × 4.91 cm and 10.88 × 5.21 cm — consistent with left kidney dimensions
- Bottom row: Additional abdominal views — ~10.65 cm structure, likely left kidney
Note on the 14.19 cm measurement: This measurement visible on the image warrants correlation. The written report states spleen = 106 mm (10.6 cm), which is normal. The 14.19 cm image may represent an oblique/longitudinal measurement artifact or a different scan plane. Since the radiologist's final read is "normal study," this is likely a measurement taken at a different angle or of a different structure.
Clinical Interpretation: Normal Ultrasound in a Patient with Left Hypochondriac Pain
A normal whole abdomen ultrasound does not rule out the cause of pain. Based on Harrison's Principles of Internal Medicine and Yamada's Gastroenterology, the differential diagnosis for Left Upper Quadrant (Left Hypochondriac) pain in a lean young male includes:
Causes NOT Visible on Routine Ultrasound:
| Category | Conditions to Consider |
|---|---|
| Gastric/GI | Gastritis, Peptic ulcer disease (gastric), GERD |
| Splenic | Early splenic infarct, subcapsular hematoma, splenitis (may be subtle on US) |
| Pancreatic | Pancreatitis (tail of pancreas — check lipase) |
| Musculoskeletal | Rib/intercostal muscle strain, costochondritis |
| Pleural/Pulmonary | Left lower lobe pneumonia, pleuritis |
| Renal | Left renal colic/early stone (urine microscopy) |
| Functional | Functional dyspepsia, splenic flexure syndrome (trapped gas in colon) |
| Other | Subdiaphragmatic abscess, left adrenal pathology |
(Harrison's Principles of Internal Medicine 22E, Differential Diagnosis of Left Upper Quadrant Pain)
Recommended Next Steps
Given normal ultrasound + left hypochondriac pain in a 22-year-old lean male:
- Serum lipase & amylase — rule out pancreatitis (tail of pancreas can be missed on US)
- Urine routine/microscopy — rule out microhematuria (renal stone)
- CBC — check for leukocytosis (infection), anemia
- Upper GI endoscopy — if clinical suspicion for gastritis/PUD (especially if associated with epigastric discomfort, nausea, H. pylori risk)
- Chest X-ray — rule out left lower lobe pneumonia, pleural effusion
- CT abdomen (with contrast) — if pain persists or worsens; more sensitive for splenic infarct, pancreatic tail, bowel pathology
- Clinical reassessment — palpation for splenic tenderness (Traube's space), Castell's sign
Key Point
The spleen at 106 mm is normal (upper limit ~120 mm). The kidneys are also normal bilaterally. The ultrasound does not identify the source of pain, which is common — many causes of left hypochondriac pain (gastritis, pancreatitis, musculoskeletal, pleuritis) are sonographically occult. Further clinical and laboratory workup is essential.
(Sources: Harrison's Principles of Internal Medicine 22E; Yamada's Textbook of Gastroenterology 7th Ed.)
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