title: An unusual cause of Grey Turner's sign.
abstract: A woman in her late 70s presented to the acute general surgical take with a 3-day history of worsening right leg pain and swelling. She had undergone right revision total hip arthroplasty 20 months previously and reported chronic postoperative right thigh pain attributed to a femoral deep venous thrombosis for which she had been warfarinised. On examination, Grey Turner's sign (bruising of the flanks indicating retroperitoneal haemorrhage) was present, as well as a large tender mass in the right iliac fossa and pitting oedema throughout the right lower limb. Urgent CT scan with intravenous contrast revealed a right retroperitoneal haematoma secondary to a right acetabular screw protruding into the right external iliac vein. The patient was successfully managed with warfarin reversal and surgical removal of the relevant acetabular screw. At 2-month follow-up, the patient's symptoms continue to resolve.
authors.affiliation: Department of Trauma and Orthopaedics, Musgrove Park Hospital, Taunton, UK. oliver.gosling@doctors.org.uk
authors.forename: Oliver Burton
authors.initials: OB
authors.lastname: Gosling
authors.forename: Alison Emma
authors.initials: AE
authors.lastname: Hunter
authors.forename: Gray Alexander Dyfan
authors.initials: GA
authors.lastname: Edwards
authors.forename: Benjamin
authors.initials: B
authors.lastname: Squires
mesh_terms: D000368:Aged; D000925:Anticoagulants / Q000009:adverse effects*; D019644:Arthroplasty, Replacement, Hip; D001863:Bone Screws / Q000009:adverse effects*; D003288:Contusions / Q000000981:diagnostic imaging / Q000209:etiology*; D005260:Female; D006470:Hemorrhage / Q000000981:diagnostic imaging / Q000209:etiology*; D006801:Humans; D007084:Iliac Vein / Q000000981:diagnostic imaging / Q000293:injuries*; D011859:Radiography; D012187:Retroperitoneal Space; D020246:Venous Thrombosis / Q000150:complications / Q000188:drug therapy*; D014859:Warfarin / Q000009:adverse effects*
chemical_list: D000925:Anticoagulants; D014859:Warfarin