Saudi Journal of Gastroenterology
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RADIOLOGY QUIZ Table of Contents   
Year : 2008  |  Volume : 14  |  Issue : 4  |  Page : 214-215
Tender thigh in a patient with Crohn's disease


Department of Medicine, Section of Gastroenterology, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia

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How to cite this article:
Al-Saeed A, Helmy A, Al-Ashgar H, Al-Kahtani K. Tender thigh in a patient with Crohn's disease. Saudi J Gastroenterol 2008;14:214-5

How to cite this URL:
Al-Saeed A, Helmy A, Al-Ashgar H, Al-Kahtani K. Tender thigh in a patient with Crohn's disease. Saudi J Gastroenterol [serial online] 2008 [cited 2019 Nov 13];14:214-5. Available from: http://www.saudijgastro.com/text.asp?2008/14/4/214/43283


A 25 year-old-male was known to have fistulizing Crohn's disease complicated with prerectal, pararectal, and gluteal abscesses as well as sacroiliac osteomyelitis. He underwent status fistula repair (twice) and abscess drainage (twice). He presented to the emergency department with pain in the right upper thigh of one day's duration. The pain was continuous, of rapid onset, moderate in severity, pressure-like in nature, aggravated by walking, and was associated with fever, chills, rigor, and arthralgia. He also had a dull-aching abdominal pain, and frequent nonbloody diarrhea with mucus. He denied any vomiting, weight loss, or ocular pain or redness. A review of other systems did not reveal any remarkable results.

Clinically, he was conscious, oriented, had a temperature of 38.9˚ C, a pulse of 115 beats per minute, blood pressure of 88/50 mm Hg, and a respiratory rate of 18 breaths per minute. His chest, cardiovascular, and central nervous system examinations also did not reveal any remarkable results. His abdomen was soft, lax, but mildly tender below the umbilicus. Local examination of the site of pain showed a swelling in the right upper thigh that was hot and tender, but with no crepitus. He was unable to move his right hip, but had intact peripheral pulses.

Laboratory investigations showed a white blood cell count of 15000 per mm3, a hemoglobin level of 120 g/l, and a platelet count of 268 000 per mm3. He underwent hip and thigh X-rays [Figure 1] as well as CT scans of the abdomen and pelvis [Figure 2A] & [Figure 2B].


   Questions Top


  1. Describe the radiological finding of [Figure 1], [Figure 2A] and [Figure 2B]?
  2. What would be the most dangerous differential diagnosis?
  3. What would be the appropriate management plan?




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Correspondence Address:
Abdulwahed Al-Saeed
Department of Medicine, Section of Gastroenterology,MBC: 46, King Faisal Specialist Hospital and Research Centre, P.O. Box 3354, Riyadh 11211
Saudi Arabia
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/1319-3767.43283

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    Figures

  [Figure 1], [Figure 2A], [Figure 2B]



 

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