From the Guidelines
For a 71-year-old female with left groin pain for 4 days requiring outpatient workup, I recommend a computed tomography (CT) scan as the preferred imaging test to evaluate the severity and extent of disease, particularly to rule out diverticulitis, which is a common cause of left lower-quadrant pain in this age group. The patient's symptoms and age suggest a possible gastrointestinal cause, and CT scan is the most appropriate test to diagnose diverticulitis and other causes of left lower-quadrant pain, as stated in the American College of Radiology Appropriateness Criteria 1.
The differential diagnosis for left groin pain in a 71-year-old female is broad and includes gastrointestinal, gynecologic, and renal/ureteric pathology. However, given the location of the pain, diverticulitis should be considered, especially since it occurs in up to 80 percent of persons by 80 years of age 1. A detailed history and physical examination should be performed to assess for signs of infection, such as fever and leukocytosis, which are commonly associated with diverticulitis.
Laboratory tests, including complete blood count and inflammatory markers (ESR, CRP), should be ordered to assess for infection or inflammatory conditions. Initial pain management can include acetaminophen 650-1000mg every 6 hours or NSAIDs like ibuprofen 400-600mg every 6-8 hours if not contraindicated by renal function or other comorbidities. The patient should be advised to return for reevaluation if symptoms worsen or fail to improve within 1-2 weeks.
It is essential to note that while other imaging modalities, such as magnetic resonance imaging (MRI) and transabdominal ultrasonography, can be used to assess left lower-quadrant pain, CT scan is the preferred test due to its ability to evaluate the severity and extent of disease and identify complications, as recommended by the American College of Radiology Appropriateness Criteria 1.
From the Research
Possible Causes of Left Groin Pain
- Fractures at or near the pubic symphysis, as seen in a 71-year-old osteoarthritic woman who developed left groin pain and tenderness over the pubic symphysis after a minor fall 2
- Iliopsoas tendon rupture, as illustrated in an 86-year-old woman with severe hip and groin pain, where an MRI revealed a rupture of the iliopsoas tendon at its insertion on the lesser trochanter 3
- Groin strain, pelvic stress fracture, avulsion injury, or tumor, which can be confused with a groin strain and require differential diagnosis to prevent serious complications 4
- Occult hip fracture, which may not be radiographically evident and require point-of-care ultrasound or computed tomography for diagnosis, as seen in an 81-year-old woman with right hip pain after a fall 5
Diagnostic Considerations
- Projection radiography is the method of choice for the diagnostic work-up of osteoarthritis of the hip joint 6
- Computed tomography can assess the amount of acetabular bone stock prior to total hip arthroplasty in selected patients 6
- Magnetic resonance imaging can substantiate the indication of surgery in case of discrepancy between clinical symptoms and radiological findings of the hip joint, and can also depict early symptoms and signs of activity of the disease 6
- Functional cartilage imaging can verify changes in the biochemical composition of the cartilage before they become morphologically evident 6