The Back Pain Edition: A Mysterious Case of Back Pain

​​BY SEFAKO PHALA; ​ROBERT STATZ; ANDREW VICTOR; MOHAMMED HASSAN-ALI, MD, MSC; & AHMED RAZIUDDIN, MDA 65-year-old Caucasian man was brought to the ED via ambulance complaining of worsening upper back pain for one week. His primary care physician had recently prescribed him NSAIDs and muscle relaxants, which failed to provide relief. The newest symptoms were numbness and weakness over his left arm and leg. The patient reported no history of trauma to his back nor did he have any chronic illnesses. Physical exam showed paresthesia in the left upper extremity in a dermatomal distribution pattern that suggested further evaluation in determining the underlying cause of this atypical back pain.​A laboratory workup was ordered including CBC, CMP, TSH, PSA, blood glucose, and urine analysis in addition to a CT scan of the thoracic and lumbar spine. The laboratory results were within normal limits. The CT report of the thoracic spine scan revealed a soft tissue mass associated with a pathologic fracture containing lytic lesions of the T2 and T3 vertebral bodies. An MRI confirmed CT findings alongside additional spinal cord displacement at the level of T2. A differential diagnosis of a single thoracic spinal tumor was made.CT and MRI images showing vertebral disc lesion at T2 & T3.The patient was admitted for futher investigation. A full-body bone scan was performed to rule out other lytic lesions. A fine needle aspiration biopsy of the tumor was performed revealin...
Source: The Case Files - Category: Emergency Medicine Tags: Blog Posts Source Type: research