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Groin Pain

UnFiNiShEd CaSe CoMe BaCk LaTeR

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History of Present Illness:

A 62-year-old male with a history of HTN and tobacco use presents to the ED for 6 months of right hip and groin pain that initially bothered him only with activity, but is now keeping him up at night.  He did injure it slightly about 6 months ago stepping off a curb awkwardly.    He denies fever, abdominal pain or other complaints.  His doctor is trying to get an MRI approved, but the pain has become worse recently so the patient does not want to wait since he cannot even sleep properly any longer.

Vital Signs & Physical Exam:

Vital signs are normal.  Physical exam is otherwise normal except for limping.

Initial Differential Diagnosis: 

Relevant Test Results:

  • 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?

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ANSWERS:

  1. What does the case image show?  The image shows no evidence of hip arthritis but does show fairly extensive calcification.
  2. What should you do next?  Order an arterial duplex
  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: Arterial duplex showed poor flow but no stenosis.  A CT angio of the aorta and iliacs was recommended and showed near complete occlusion of a short segment of the right iliac artery.

CASE LESSONS:

  1. Always
  2. Never
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