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A 15 year old girl had a 20-month history of right sided belly pain associated with nausea, poor appetite, and intolerance to fatty food.

The only positive physical examination was pain and tenderness over the right ninth and tenth costal ribs (the lower ribs).

Studies had been done were the following: abdominal ultrasound, upper gastrointestinal contrast study, abdominal CT, biliary radionuclide scan, laparoscopy, and liver function tests, and test for connective tissue disorders. All of them were normal.

A 13 year old had a one-year history of recurrent right lower chest pain. Some of the pain were severe enough that resulted to hospitalization. He was symptom free between the lower chest pain attacks.

The only positive physical finding was pain over his right lowest ribs when palpated or pressed on.

Both of these teens had similar diagnosis.

Click here for the Diagnosis

Reference: Year Book of Pediatrics, 1999, page 336

Leo Leonidas, MD, FAAP, Assistant Clinical Professor in Pediatrics, Tufts University School of Medicine, Boston; Attending Pediatrician, Eastern Maine Medical Center, Bangor, Maine.

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