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Image in Emergency Medicine “Hanging ” Pelvic Gallbladder Simulating Occult Hip Fracture Versus Appendicitis

By Katherine W. Davisson, George L. Higgins Iii and Michael W. Jung


An 81-year-old Caucasian woman presented to the emergency department (ED) complaining of right groin pain of one month’s duration. She was able to bear weight but was finding it increasingly difficult to ambulate. She described a vague history of falling, prompting a prior negative work-up for hip fracture. In the ED, she was noted to be kyphotic, but exhibited no signs of trauma. Exam revealed tenderness to deep palpation in the right lower quadrant without rebound or mass. She had full range of motion of her right hip with minimal discomfort, but hip extension elicited a positive psoas sign. Given concern about the possibility of either an occult hip fracture or a subacute presentation of appendicitis, imaging studies were ordered. The patient had an inflamed pelvic gallbladder. Anatomic malposition of organs can result in unusual clinica

Year: 2009
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