What A Kick

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What A Kick - Page #3

Lab Studies: Erythrocyte sedimentation rate- 27 (elevated) C-reactive protein- 15.2 (elevated) Von Willebrand Factor Ag- 193% (elevated) - Von Willebrand Factor Ag can be increased from chronic or acute inflammatory diseases or processes. Urine Analysis- Within normal limits Complete Metabolic Panel- Within normal limits Complete Blood Count- Within normal limits with mild reactive thrombocytosis of 465 Prothrombin time/international normalized ratio- Within normal limits Bleeding time- Within normal limits Creatine Kinase- Within normal limits Other Studies: Point of Care Ultrasound performed on the initial exam: Mild edema and disorganization of the proximal muscle/tendon fibers of the adductor near its origin. No full-thickness tear or retraction. Pelvic X-Ray on initial presentation: Osteitis Pubis. Case Photo #1 Initial Pelvic MRI without contrast revealed a left adductor partial tear, athletic pubalgia syndrome, and a partial left rectus abdominis aponeurosis tear. Case Photo #2 and Case Photo #3 A subsequent MRI Pelvis without contrast four months later showed three pelvic masses {within the left obturator (5 cm x 2.2 cm x 4 cm), abutting the urinary bladder (5 cm x 4c m x 5 cm), and right rectus abdominis muscle (2.4 cm x 4.4 cm x 7 cm)} suggestive of hematomas and redemonstration of the initial MRI findings. Case Photo #4 , Case Photo #5 , and Case Photo #6 CT Scan Abdomen and Pelvis with contrast at 4 months: Redemonstration of stable non-expanding 3 pelvic hematomas (within left obturator, abutting the urinary bladder, and right rectus abdominis muscle). MRI Pelvis without contrast 6 months later: Showing decreasing pelvic hematomas with only bladder abutting hematoma still prominent. Redemonstration of bony edema along pelvic symphysis. Case Photo #7 and Case Photo #8 MRI Pelvis without contrast 11 months later: Complete resolution of previous pelvic hematomas. Redemonstration of bony edema along pelvic symphysis. Case Photo #9 and Case Photo #10 Consultations: Interventional Radiology: For evacuation of pelvic hematomas. Subsequently determined, not necessary after CT Scan showed no expansion of hematomas. Click here to continue. Challenge yourself by writing down a revised, working diagnosis before moving to the next slide.		Back
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