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BACKGROUND
A 35-year-old man presents to the emergency department
complaining of sacral and right hip pain. The pain is
associated with increasing swelling in that region over
the last 3 days. The patient otherwise denies having any
systemic symptoms, such as fevers, chills, nausea, or
vomiting. His medical history is significant for a
recent admission to the hospital after an accident with
a motor vehicle approximately 2 weeks ago. He was a
pedestrian struck by a car, sustaining multiple rib
fractures and facial lacerations. He was discharged home
from the hospital 10 days ago and has been doing
relatively well, with adequate pain control for his rib
fractures.
On physical examination, the patient's temperature is
37.2°C with a blood pressure of 129/67 mm Hg and a heart
rate of 89 beats per minute. His respiratory rate is 20
breaths per minute, and his O2 saturation is 95% on room
air. The patient is in no acute distress. Head, eyes,
ears, nose, and throat (HEENT) examination shows
well-healing facial lacerations with intact sutures. His
chest is clear to auscultation on both sides, with
normal cardiovascular and abdominal findings. The lower
extremities have normal sensation and 5/5 strength.
A visible fluid collection is observed in the
proximal-lateral aspect of his right thigh. The fluid
seems to track up around the gluteus maximus muscle and
to the lumbosacral region, with slight crossing of the
midline to the left (see Image 1). The fluid appears to
be a free-flowing, low-viscosity collection with no
evidence of erythema or ecchymosis. No loculation is
noted on palpation, and the patient has no thickening or
induration of the skin overlying and surrounding the
area.
What is your clinical diagnosis? |
Hint
This fluid collection was not appreciated
during the patient's previous admission to the hospital. |
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Authors:
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Gil Z. Shlamovitz, MD,
UCLA/Olive View-UCLA Emergency Medicine Residency,
UCLA Emergency Medicine Center,
UCLA Medical Center,
David Geffen School of Medicine,
Los Angeles, Calif
Rick G. Kulkarni, MD,
Assistant Professor,
Yale School of Medicine,
Section of Emergency Medicine,
Department of Surgery, Attending Physician,
Medical Director,
Department of Emergency Services,
Yale-New Haven Hospital, Conn |
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eMedicine
Editor:
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Eugene Lin, MD,
Department of Radiology,
Virginia Mason Medical Center,
Seattle, Wash,
Assistant Clinical Professor of Radiology.
University of Washington
Medical Center, Seattle, Wash |
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