unusual case presentation- back pain
DESCRIPTION
Unusual case presentation- Back pain. Mr.Manoj Krishna - Spine Surgeon Shailesh Hadgaonkar - Spinal Fellow. 65 yr,male ,meets General Surgeon for- C/o Abdominal pain, back pain Uneasiness Mid back pain+girdle pain O/E – No Clinical findings. No abdominal or spinal tenderness. Advice. - PowerPoint PPT PresentationTRANSCRIPT
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Unusual case presentation-Back pain
Mr.Manoj Krishna - Spine SurgeonShailesh Hadgaonkar - Spinal
Fellow
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65 yr,male ,meets General Surgeon for-
C/o Abdominal pain, back pain Uneasiness Mid back pain+girdle pain
O/E – No Clinical findings. No abdominal or spinal tenderness.
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Advice Ultrasound Abdomen X-Ray Abdomen
Report Liver-fatty change, rest normal
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First Evaluation
X-ray abdomen- normal
Ultrasound abdomen normal
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Referral to Spinal Unit-
(After 10 days) Neurology Assessment Thorough clinical Exam. Investigations-I. MRI-Dorsal+Lumbar SpineII. X-Rays of Spine
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Clinical Examination
Points to Right Iliac Crest as area of the pain
Mild tenderness at L5/S1 area On questioning reported some loss of appetite- a red flag
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X-Rays –Ap/Lat.
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Sagittal Mri-T2 &T1 images
Degenerate L5/S1 Disc and Spondylo-listhesis at this level.
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Axials Image Coronal Image
No Neural Compression at L5/S1
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X-ray showed-Lytic Listhesis,(Mild)Grade 1, L5 over S1(Can be incidental finding on x - ray with no symptoms)
Hence, the Spinal Surgeon advised for a CT Scan Chest &
Abdomen-
Suspecting something remote- also because of the loss of
apetite .
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CT Scan –Tumour of the head of the Pancreas
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Confirm Diagnosis Bulky Necrotic Tumoral Mass in the Body of Pancreas(Measuring approx
5.9X3.5cm,engulfing spleenic artery & vein) extending to tail.
Pancreatic Carcinoma.
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Take Home Messages Pain can be referred to the spine from abdomen and chest lesions
Loss of appetite was the clue Exercise caution about abnormal MRI findings- they can be incidental in up to 50% of cases.
Need to marry up the clinical and radiological picture.