Diagnosis of Hip Effusion with Bedside Ultrasound in the Emergency Department

The use of bedside ultrasound by emergency physicians has dramatically increased over the past twelve years. Its use has led to increased speed of diagnosis, expedited disposition, and improved quality of emergency care. While there are eight primary applications of emergency ultrasound, its increasing presence in the emergency department (ED) has led to broader utilization of this diagnostic modality. One of the primary applications, ultrasound-guided line placement, requires the use of a linear higher frequency probe. As this probe becomes more widely available to emergency physicians, its utility is expanding into other diagnostic applications. We describe its use in a patient who presented to the ED with left hip pain. The ED attending performed a bedside ultrasound, which demonstrated an effusion in the left hip joint. Orthopedic surgery was consulted; arthrocentesis revealed a white blood cell (WBC) count of 108,000 /uL and the patient was immediately taken to the OR for washout of his hip. CASE