ChiroACCESS Article



Diagnostic Imaging Case Report: A 62-year-old female reports low back 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

September 10, 2010

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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 62-year-old female reports low back pain of four weeks.  Pain is most intense in the early morning.  No history of recent trauma was reported.  The patient’s past medical history and physical exam findings were not provided.






FINDINGS

The study is negative for acute fracture or dislocation.  Moderate osteopenia is present throughout the structures visualized.  Degenerative changes are noted throughout the lumbar spine.  Please note an ill-defined focal sclerotic lesion overlying the region of the third sacral segment right of mid line.  This lesion is noted on both frontal and lateral views.

 
DISCUSSION

Focal sclerotic lesions in patients 40 years and older should be considered blastic lesions until proven otherwise.  This particular lesion is extremely suspicious appearing and most likely represents blastic METS.

 
FOLLOW UP PROTOCOL

If possible, comparison with previous images would be helpful.  A lumbar/pelvic MRI would be sensitive and specific for the diagnosis.
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