Fri12November0729PM 4

A 67-year-old gentleman presented to hospital with significant back and groin pain. He had no history of trauma, malignancy, or previous back problems, and was taking treatment for hypertension and type 2 diabetes, as well as taking rivaroxaban for atrial fibrillation (AF).

Examination revealed a blood pressure of 108/67 mmHg and a tachycardia of 102/min. His urine dip showed 1+ protein and 1+ blood. There were no abnormalities on chest and neurological examination; however, he had pain on flexion of his hip. His condition initially improved with fluid resuscitation.

Which of the following is the most likely diagnosis?

(Please select 1 option)

Diabetic nephropathy

Renal calculi

Retroperitoneal haematoma Correct

Myeloma

Iliopsoas abscess

Explanation

In this question, the key points are the history of anticoagulation, relative hypotension, and partial response to fluid resuscitation.

These point to a diagnosis of a possible bleed and of the options available, a retroperitoneal haematoma is certainly possible. This is a rare clinical presentation which is often missed due to non-specific symptoms. Spontaneous haemorrhage may occur in those who are anticoagulated.

Most patients require clotting studies, CT, and possible arteriography.

Endovascular treatment options are available and most haemodynamically stable patients can be managed conservatively.

Answer Statistics

1

2%

2

15%

3

59%

4

3%

5

23%

Times answered: 307