Pain from an Unknown Cause

​"My left hip has been hurting for a couple years, but it just got really bad in the past few weeks."My patient, who was in her 70s, didn't add much more to the history. No trauma. No fevers. No bowel or bladder problems. No significant past medical history. Her hip just hurt. She thought she needed an x-ray, and one was obtained.The left femoral head didn't look terrible. There was some irregularity, but there were no fractures or significant joint narrowing. This wasn't a case of neglected severe degenerative joint disease or avascular necrosis that needed a hip replacement.Some red flags started to show up toward the left iliac bone. The trabecular pattern was just not right. It wasn't uniform in lines or density. The cortex had discontinuous areas. Clearly, it didn't look like the other side. She didn't have a history of cancer, but this bony destruction could certainly be a metastatic neoplastic disease.The next step, a noncontrast pelvic CT, clearly showed the malignant disruption of the bone. She was admitted for pain control and to initiate her metastatic cancer workup to define the extent of the disease of unknown primary.Tip to RememberThe elderly patient with unremitting pain may have cancer in her bones. Sometimes this is the presenting complaint for a cancer diagnosis.When one is unsure of hip or bony pelvis pathology, a noncontrast CT scan can assist with defining the path.Tags: hip pain, elderly patient, x-ray, femoral head, iliac bone, trabecular p...
Source: Lions and Tigers and Bears - Category: Emergency Medicine Tags: Blog Posts Source Type: blogs