The Case Files: A Case of Hip Pain Masquerading a More Serious Problem

By Moises, Moreno DO; Glantz, Sanford DO   A 66-year-old woman with a history of osteoarthritis presented to the emergency department with progressively worsening left hip pain that had started five days prior to arrival. The pain was non-radiating and worse with movement, and it was associated with chills and anorexia. She had progressive difficulty walking because of pain. She had not had similar symptoms in the past, and attributed her pain to osteoarthritis. She denied recent trauma, back pain, leg swelling, numbness, and paresthesias. She also denied fever, abdominal pain and distention, nausea, vomiting, diarrhea, constipation, urinary symptoms, allergies, alcohol, and drug use.   She was a well-appearing obese woman in no acute distress. Her blood pressure was 158/100 mm Hg, and her temperature was 100.2°F. She had left lower quadrant abdominal tenderness without distention, guarding, or rigidity; she also had no costovertebral angle tenderness, hernias, or masses. Her pain was greatest with active range of motion of the left hip. The remainder of her physical exam was unremarkable. The patient's white-cell count was 16,140 per cubic millimeter without a left shift or bandemia. X-rays of left hip and pelvis were unremarkable. A non-contrast CT of the abdomen and pelvis was obtained because of her abdominal tenderness. The CT revealed a 3.9 cm fine linear foreign body within a loop of small bowel in the upper pelvis that appeared to extend through the lateral wall a...
Source: The Case Files - Category: Emergency Medicine Tags: Blog Posts Source Type: research