Does a 72-year-old male with right-sided back pain need a CT (Computed Tomography) scan of the left hip?

CT of Left Hip is Not Indicated for Right-Sided Back Pain in a 72-Year-Old Male

A CT scan of the left hip is not indicated for a 72-year-old male presenting with right-sided back pain, as imaging should be directed at the symptomatic area and follow a systematic diagnostic approach. 1

Diagnostic Approach for Back Pain in Older Adults

Initial Assessment

• Right-sided back pain requires evaluation of the right side of the spine and potentially right hip—not the contralateral (left) hip
• Initial imaging should include:
  • AP pelvis and lateral femoral head-neck radiographs to assess bony morphology 1
  • Lumbar spine radiographs to evaluate for degenerative changes, fractures, or other pathology 1

Appropriate Next Steps

1. If radiographs are negative but symptoms persist:

   • MRI of the spine (without contrast) is preferred for:
     • Soft tissue evaluation
     • Detection of bone marrow edema
     • Assessment of nerve compression 1, 2

2. If hip pathology is suspected:

   • Evaluate the symptomatic (right) side, not the asymptomatic (left) side 2, 3
   • Ultrasound can assess extra-articular soft tissue abnormalities (tendinitis, bursitis) 2
   • MRI without contrast is superior for intra-articular pathology 2

Important Clinical Considerations

Referred Pain Patterns

• Right-sided back pain could originate from:
  • Lumbar spine pathology (most common)
  • Right hip pathology (referred pain)
  • Visceral causes (kidney, retroperitoneal)
  • Sacroiliac joint dysfunction 3

Red Flags Requiring Urgent Evaluation

• Night pain, weight loss, or history of cancer may indicate malignancy 4
• Fever may suggest infection
• Severe pain unresponsive to conservative measures requires prompt evaluation 2

Cross-Sectional Imaging Indications

• CT spine is indicated for:
  • Detailed bony architecture assessment
  • Suspected fractures not visible on radiographs
  • Evaluation of mineralization 1
• MRI is preferred for:
  • Soft tissue pathology
  • Marrow edema
  • Nerve compression 1, 2

Diagnostic Pitfalls to Avoid

1. Imaging asymptomatic areas: Focusing on the left hip when pain is on the right side is inappropriate and may lead to incidental findings unrelated to symptoms 1, 5

2. Premature advanced imaging: Starting with CT or MRI before appropriate radiographs wastes resources and may delay proper diagnosis 1, 2

3. Missing referred pain patterns: Back pain can be referred from hip pathology and vice versa; systematic evaluation is needed 3, 5

4. Overlooking serious pathology: Failure to recognize red flags may delay diagnosis of cancer, infection, or fracture 4

In conclusion, for a 72-year-old male with right-sided back pain, imaging should focus on the symptomatic area starting with radiographs, followed by appropriate advanced imaging of the spine or right hip if indicated. A CT of the left hip is not appropriate in this clinical scenario.