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Hip Pain in a Man with Type 1 Diabetes: Seen in the ED


Patient is in his forties; pain has been waxing, waning, worsening for 2 weeks. He has no other significant medical history. Do lab results hold clues? What's your Dx?

D Brady Pregerson, MD
D Brady Pregerson, MD

History of present illness. A man in his mid-forties with a history of type 1 diabetes presents to the emergency department (ED) after 2 weeks of waxing and waning but gradually worsening right groin and inner thigh pain that is aggravated by activity. Currently even at rest it is painful, and he is unable to sleep. He has also started using a cane for the first time in his life to assist ambulation. He denies any injury or fever but has had chills. He denies any rash or other complaints. Other than diabetes, he has no other significant past medical history and denies any recreational drug use.

Vital signs and physical examination. Vital signs are normal except for a temperature of 99.3°F. Physical examination is otherwise normal except for limping and pain with logrolling of the affected hip. There is more severe pain with forced internal rotation of the involved hip.

Initial diagnostic testing

UA: shows hematuria without pyuria
: WBC = 9.4, Hb = 12.9, PLT = 519. ESR and CRP both moderately elevated
: glucose 316, sodium 131. Everything else normal. No anion gap
: see ultrasound image below

Hip pain in a man with type 1 diabetes: seen in the ED
Courtesy of D Brady Pregerson, MD

What does the ultrasound image show?

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