Today, a poor girl, age 12 years, came with pain over left upper quadrant of abdomen and breathlessness on sitting, since 4-5 days. She had gone to a govt hospital, where the doctor had done ultrasound and serum creatinine and advised CT scan. The doctor has stated that without CT scan report, he is not going to give any medicine. She doesn't look anaemic. I have advised for a CBC and ESR. She doesn't have any significant past history. Normal growth. The pain is from 4-5 days.
Mild fever since yesterday evening. On examination, the spleen is well palpable, tender. Abdominal muscle guarding is present over the area. Temperature was 99.4 F. No abnormality detected on palpation of hepatic area. Ultrasound abdomen shows spleen size 17.3 cm with altered echotexture. I have given paracetamol with antibiotics. What should be the next step if she can't afford for CT scan?
