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A middle-aged male with sickle β thalassaemia presents to the emergency department with increasing joint, abdominal and back pain with fatigue and intermittent fevers, nausea and vomiting for 1 week. Vital signs included a pulse of 99 beats/min, BP of 144/82 mm Hg, RR of 16 times/min, a pulse oximetry of 100% on room air, and temperature of 37.0. On physical exam, he had mild, diffuse abdominal pain with a normal motor-sensory exam of the lower extremities but increased left hip pain on extension of left leg. He kept his knees and hips in a flexed position. Labs revealed a normal leukocyte count, haemoglobin and reticulocyte count.
What are the concerning historical and physical exam findings?
What imaging should be considered?
What does the CT (figure 1) demonstrate?
What other work-up should be obtained?
How should these patients be treated?
This patient does not appear to be having a vaso-occlusive crisis. Although he is afebrile and does not have a leukocytosis, he is relatively immunocompromised and may not mount …
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