Answer of January 2011

Clinical History:

A 23-years-old man who has a history of recurrent abdominal and joint pain presented with left lower quadrant pain for 2 days. CT abdomen was performed. Previous XR ankle and knee are also available for review. 

Diagnosis:

Haemophilic arthropathy and acute intra-abdominal bleeding

Discussion:

CT abdomen shows hyperdense free peritoneal fluid, compatible with haemoperitoneum. There is a space-occupying lesion in the RUQ with heterogeneous density and no significant enhancement, which represents a haematoma. A segment of small bowel in LLQ shows hyperdense wall thickening, consistent with intramural haematoma. Previous XRs of the ankle and knee show accelerated degenerative changes for this young patient. There is mild enlargement of the epiphysis and intercondylar notch. Overall features are compatible with haemophilia causing haemophilic arthropathy and acute intra-abdominal bleeding.