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Hip Pain for 2 weeks

UnFiNiShEd CaSe CoMe BaCk LaTeR

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History of Present Illness:

A 40-ish-year-old male presents to the ED for 2 weeks of waxing and waning right hip pain that is aggravated by activity.  He cannot sleep due to the pain and started using a cane for the first time in his life.    He denies any injury or fever or drug use or other complaints

Vital Signs & Physical Exam:

Vital signs are normal except for   Physical exam is otherwise normal except for severe pain with forced internal rotation of the hip.

Initial Differential Diagnosis:

  • Syphilis, the great imitator

Initial Diagnostic Testing:

  • EKG: none
  • Labs: WBC = 12, Hb = 12.9, plt = 519.  CRP and ESR elevated
  • Imaging: see below

QUESTIONS:

  1. What does the case image show?  
  2. What should you do next?  
  3. Want a 1-minute consult/tutorial on this case? 
  4. Want to know what happened with this patient?

SCROLL DOWN FOR ANSWERS & 1-MINUTE CONSULT

 

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ANSWERS:

  1. What does the case image show?  The image shows a hip effusion.
  2. What should you do next?  Consult ortho and IR to tap the hip
  3. Want a 1-minute consult/tutorial on this case?  See yellow area from sample page below.
  4. Want to know what happened with this patient?  See case conclusion below tutorial page.

1-Minute EM Consult on the topic for this case from the Emergency Medicine 1-minute Consult Pocketbook

CLICK HERE TO LEAR MORE ABOUT THIS BOOK

CASE CONCLUSION: Tap showed 200,000 WBC with 87% PMN’s and grew 4+ staph aureus, MSSA.  Went to OR.    Treated with 6 weeks of Ancef

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