CASE 44

History: A 36-year-old man presents with fever and rigors, left flank and groin pain, and positive psoas sign on examination.

1. Which of the following should be included in the differential for the origin and diagnosis of the disease leading to the imaging finding shown in Figure A? (Choose all that apply.)

A. Acute appendicitis

B. Tuberculosis of the spine

C. Crohn’s disease of the small bowel

D. Infected aortic aneurysm

E. Idiopathic

2. What is the psoas sign?

A. Palpation of the inferior iliopsoas muscle in the left iliac fossa of a patient’s abdomen results in pain in the right iliac fossa.

B. Leg lifting, or flexion of the hip, on the affected side elicits pain.

C. Abdominal pain is elicited by passive flexion and external rotation of the hip.

D. There is dullness to percussion in the left flank.

3

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