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Case of the Week 197: Courtesy of Dr. Jörg Häusler, DC, Luzern, Switzerland

Case of the Week 197: Courtesy of Dr. Jörg Häusler, DC, Luzern, Switzerland. 24 year old male carpenter has presented a few times with acute onset of low back pain which responds quickly to treatment. On this last presentation Dr. Häusler took lumbar spine radiographs.

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Case of the Week 197: Courtesy of Dr. Jörg Häusler, DC, Luzern, Switzerland

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  1. Case of the Week 197: Courtesy of Dr. Jörg Häusler, DC, Luzern, Switzerland 24 year old male carpenter has presented a few times with acute onset of low back pain which responds quickly to treatment. On this last presentation Dr. Häusler took lumbar spine radiographs.

  2. What are the abnormal radiographic findings? What is the differential diagnosis?

  3. ANSWERS Abnormal Findings: Nephrocalcinosis is diffusely present in both kidneys. On the lateral view this is superimposed over the vertebral bodies as the kidneys are retroperitoneal structures. Differential Diagnosis: The causes of nephrocalcinosis include anything that increases the calcium level in the blood such as hyperparathyroidism, hypervitaminosis D, lytic metastasis, multiple myeloma, sarcoidosis etc. Additionally, this appearance is seen in a condition called Medullary Sponge kidney. DX: This patient knew that he had medullary sponge kidney as it was previously diagnosed. He had failed to mention it to Dr. Häusler during the case history however and it only came to light after the radiographs were taken.

  4. Medullary Sponge Kidney • This is a birth defect of the renal tubules where tiny cysts form in the medulla creating a sponge-like appearance. • These cysts cause stasis of urine with resulting stone formation. • Most cases do not appear to be inherited but, as in this case, a few hereditary cases have been reported. • Most patients remain asymptomatic at least until ages 30 – 40. If symptomatic, hematuria, kidney stones or urinary tract infections are the usual problems.

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