Pain Images: Hip Pain - Wrong Diagnosis, Wrong Operation

Abstract

Objective: The clinical presentation of retroperitoneal schwannoma with neuropathic pain and its subsequent management is presented. Design and Setting: This is a case report of a 67-year-old woman who developed left hip pain radiating into the postero-lateral portion of her left thigh and extending to the knee. Intervention: The patient underwent a left hip replacement for suspected pain from osteoarthritis of the hip joint. Outcome Measure: The location of her pain was unchanged from the initial presentation, and more extensive investigations were carried out. Result: The pain was found to be neuropathic in nature caused by a 54 mm retroperitoneal schwannoma. Conclusion: Our case demonstrates the principle that unless the diagnosis is very clear (based on history, examination and diagnostic local anaesthetic injection, and confirmed by special investigations), surgery should not be considered. Where doubt exists, further assessment and investigation is required. Wiley Periodicals, Inc.