Radiology Review

Elderly Man Failed To Mention Hip Pain After Fall

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An 87-year-old man is admitted to the hospital with a traumatic subarachnoid hemorrhage secondary to a fall down some steps. He is taking warfarin for atrial fibrillation; because his INR is elevated, he is placed in the ICU for close observation and warfarin reversal. His medical history is otherwise unremarkable, except for mild hypertension. During rounds, he complains of severe hip pain, possibly related to the fall. He admits that he “probably didn’t mention this” while he was in the emergency department. Physical examination demonstrates moderate tenderness and bruising in the left hip. No obvious leg shortening is noted. There is pain in the left hip with abduction and adduction, as well as with internal and external rotation. Good distal pulses are noted, as well as good color and sensation. His vital signs are normal. You order a portable pelvis radiograph (shown). What is your impression?


The radiograph demonstrates diffuse bony demineralization, as well as generalized degenerative changes. No obvious fracture or dislocation of the hip joint is seen.

Of note, though, are air lucencies within the area of the scrotum. This most likely represents a bowel finding and is strongly suggestive of an inguinal hernia. No acute intervention is warranted for this incidental finding; outpatient follow-up with general surgery was arranged.

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