Hip pain- MRI

[pbruss]

90 year old female on coumadin for A-fib who fell 4 days ago, complainaing of left hip pain. PCP did x-ray which was normal. PCP ordered an MIR which was was done the day before presenting to the ER. The family has the MRI on a disk but are suposed to follow up with the PCP next week for the results. The patient come in because the pain is getting worse and now can not walk on her own. Vitals are all normal, she has moderation pain with ROM of the left hip but no shortening, deformity, swelling or brusing. attached is a T2 weighted immage from the MRI which you have no report for.

based on your intrepritation of the MRI what would be the next step?

A. CT abd and pelvis
B. Joint aspiration and antibiotics
C. Rest, Nsaids and DC
D. IV heparin and vascular consult

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[gigantor]

E- I suck at MRI. Im guessing its a bunch of blood around the hip. Ill go with A, but I'm letting Ortho do it.

[pbruss]

do you mean A or B cause you said youd let ortho do it?

[Bjs04f]

Looks like a lot of soft tissue swelling and enhancement. So if that fall could cause that level of bleding I would A ct her and/ pelv make sure there's no other bleeding.

[gigantor]

I meant B.

[kemple]

I'm gonna go on a limb here and think avascular necrosis of the hip and say D.

[pbruss]

A is what i was looking for. This is a T2 weighted immage and blood is white on a T2. all the white you see on the hip is blood. if you look close, it is all outside of the joint capsule. swhen she fell she tore a muscle shich kept bleeding due to the coumadin. i outlined an area in red that shows the blood tracking back up behind the peritoneal space. she ended up having a hemaglobin of 3 and a large ammount of retroperitoneal hemmorage.

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