History of Present Illness:
A woman in her late 70’s with a history of mild dementia is brought to the ED with 1 day of left groin/hip/LLQ pain and generalized weakness. She and staff at memory care deny fever, vomiting injury or other complaints, but it is unclear how reliable they are
Vital Signs & Physical Exam:
Vitals normal except for a temp of 37.5. Leg pulses are strong. She has LLQ tenderness and pain with ROM of leg. No deformity or swelling is noted
Diagnostic Testing:
- Hip x-ray read as mild to moderate hip osteoarthritis
- Labs: WBC: 14, BUN/Cr: 45/1.7, UA: 50 wbc
- CT abdomen shown below
What is the most likely diagnosis?
- A) Colitis
- B) Psoas abscess
- C) Hip fracture
- D) Septic hip
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- Emergency Medicine 1-Minute Consult, 5th edition
- A-to-Z EM Pharmacopoeia & Antibiotic Guide, 5th edition
- 8-in-1 Emergency Department Quick Reference, 5th edition
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What is the treatment for this?
- A) Colitis
- B) Septic Hip
- C) Hip fracture – CORRECT
- D) Kidney stone
1-Minute EM Consult on the topic for this case – click here
bone window and zoomed in on left hip
CASE CONCLUSION: CT shows read by radiologist as possible mild descending colitis, but actually shows a subtle femoral neck fracture, likely from forgotten/missed fall. Radiologist missed it on both plain films and CT though it was noticeable on both. Part of the problem may have been that the patient was erroneously triaged as having right hip pain and this info may have been available to the radiologist