ChiroACCESS Article



Diagnostic Imaging Case Report: A 53-year-old female reports back pain and hip pain



This information is provided to you for use in conjunction with your clinical judgment and the specific needs of the patient.

Jack Henry, DC, DACBR

  

Radiology Diagnostics, LLC



Published on

July 19, 2011

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Hello.  My name is Jack Henry, DC, DACBR.  I am Radiologist-in-Chief of Radiology Diagnostics, LLC, an industry leader of Chiropractic Radiology Services and Digitized Spinographic analyses.  All of our services are provided at no cost to doctor and  no/low cost to patients.

Selected cases will be presented for your evaluation.  The studies may or may not have abnormalities.  Use the arrow keys or the scroll bar to carefully evaluate the films.

Step 1:  Is the study abnormal or normal?

Step 2:  If the study is abnormal, what is your best diagnosis?

Step 3:  Which follow-up imaging option would be best?

Step 4:  Compare your results with the correct diagnosis.


HISTORY

A 53-year-old female reports severe low back pain and left hip pain. The patient has great difficulty walking. Orthopedic evaluation was limited due to severe pain.







FINDINGS

There is a left curve of the lumbar spine. Marked osteopenia is noted throughout the structures visualized. Moderate degenerative changes are present. Most troubling is the lytic destructive lesion involving the left ischium. This lesion may extend into the acetabular roof. This is a relatively easy and straightforward case. Not many differentials to consider.


DISCUSSION

Lytic METS is the working diagnosis. The patient was carefully transported to a local ER to prevent pathological fracture.


FOLLOW UP PROTOCOL

An MRI confirmed METS. The patient was referred to a skilled nursing home to mitigate pathological fractures and provide a more comfortable environment.
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