Endgames Spot Diagnosis

An unusual pelvis radiograph

BMJ 2017; 357 doi: https://doi.org/10.1136/bmj.j2593 (Published 15 June 2017) Cite this as: BMJ 2017;357:j2593
  1. Yu Xi Terence Law, urology trainee1,
  2. Welras Long, medical student2,
  3. King Chien Joe Lee, consultant1
  1. 1National University Hospital, Singapore
  2. 2National University of Singapore, Singapore
  1. Correspondence to YXT Law terencelaw83{at}gmail.com

A 95 year old woman was admitted to hospital after a fall. She had sustained a hip fracture. She had Alzheimer’s disease, hypertension, and type 2 diabetes mellitus, for which she was taking metformin. A radiograph of the pelvis was obtained (fig 1). Other than the hip fracture, what is the likely diagnosis?

Fig 1 Radiograph of the pelvis


Short answer

Right femoral neck fracture (incidental finding of emphysematous cystitis).


The pelvic radiograph shows a ring of radiolucent gas with central mottled lucencies in the expected location of the bladder, suggestive of emphysematous cystitis (fig 2). A right femoral neck …

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