Unusual case presentation- Back pain

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Unusual case presentation-Back pain

• Mr.Manoj Krishna - Spine Surgeon
• Shailesh Hadgaonkar - Spinal Fellow

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• 65 yr,male ,meets General Surgeon for-
• C/o Abdominal pain, back pain
• Uneasiness
• Mid back paingirdle 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
Ultrasound abdomen normal
X-ray abdomen- normal
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Referral to Spinal Unit- (After 10 days)

• Neurology Assessment
• Thorough clinical Exam.
• Investigations-
• MRI-DorsalLumbar Spine
• 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.
Lytic Spondylo-listhesis L5/S1
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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.