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Unusual case presentation- Back pain

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.

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Unusual case presentation- Back pain

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  1. Unusual case presentation-Back pain Mr.Manoj Krishna - Spine Surgeon Shailesh Hadgaonkar - Spinal Fellow

  2. 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.

  3. Advice • Ultrasound Abdomen • X-Ray Abdomen • Report • Liver-fatty change, rest normal

  4. First Evaluation Ultrasound abdomen normal X-ray abdomen- normal

  5. Referral to Spinal Unit- (After 10 days) • Neurology Assessment • Thorough clinical Exam. • Investigations- • MRI-Dorsal+Lumbar Spine • X-Rays of Spine

  6. 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

  7. X-Rays –Ap/Lat. Lytic Spondylo-listhesis L5/S1

  8. Sagittal Mri-T2 &T1 images • Degenerate L5/S1 Disc and Spondylo-listhesis at this level.

  9. Axials Image Coronal Image No Neural Compression at L5/S1

  10. 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 .

  11. CT Scan –Tumour of the head of the Pancreas

  12. Confirm Diagnosis • Bulky Necrotic Tumoral Mass in the Body ofPancreas(Measuring approx 5.9X3.5cm,engulfing spleenic artery & vein) extending to tail. • Pancreatic Carcinoma.

  13. 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.

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