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Answers on p 630.
A 52 year old man presented to the emergency department with progressive left groin pain radiating to the leg. He had attended hospital a week previously with low back pain, at which time no specific diagnosis had been made. There was no history of preceding trauma. The pain was persistent, severe, unrelieved by rest or with analgesics, and interfered with sleep. He was unable to bear weight on the affected limb owing to hip pain and a sensation of weakness. There was no history suggestive of sphincter dysfunction. There were no associated systemic symptoms. It was noted that he was on oral anticoagulation after aortic valve replacement.
On examination, he did not appear toxic. His vital signs were within normal acceptable limits. Tenderness was noted in the left groin, lateral to the femoral arterial pulsation. The left hip was held in slight flexion, and pain was produced on passive extension of the hip. The quadriceps muscle appeared weak, and the knee jerk was diminished. Sensory deficit was noted in the distal anterior thigh and pre-patellar region. There was no evidence of vascular deficit in the lower limb. Examination of the abdomen did not reveal any mass.
Venous blood testing revealed a haemoglobin concentration of 128 g/l, white cell count 13.2 × 109/ l, platelet count 186 × 109/ l, sodium 140 mmol/l, potassium 3.5 mmol/l., urea 7.2 mmol/l, glucose 7.9 mmol/l, total protein 74 g/l, albumin 41 g/l, bilirubin 12 μmol/l, prothrombin time 7.2 (reference range 1.0–1.3), and partial thromboplastin time 73.0 sec (reference range 25–35).
Computed tomography was carried out (see fig 1).
What is the likely clinical diagnosis?
What lesion is shown on the computed tomograms?
How should this condition be managed?