Back pain…

October 7, 2014

CT, Non-Trauma, Orthopedics


Back pain is one of the most frequent complaints in the ED.  The vast majority of patients do not have a life threatening or highly morbid pathology.  Unfortunately, this patient did:

 

CT LSpine 1 LS spine 2

This is a CT scan under bone windows.  It shows erosive changes based around the L4-L5 disc, eroding into the inferior endplate of L4 and the superior endplate of L5. These findings are concerning for discitis-osteomyelitis. It is favored to have both acute
and chronic components.

Finding this pathology is somewhat like finding a needle in a haystack.  However, pay attention to signs such as fever, repeat ED visits without a firm diagnosis, focal weakness, and predisposing factors such as IV drug abuse, history of endocarditis, or immunosuppression.  Sedimentation rate and C-reactive protein are often elevated in this disorder (among others).

CT is a readily available, quick way to diagnose this pathology but it isn’t as sensitive as MRI.  Plain films are not reliable but may show changes similar to the CT above.  Nuclear medicine bone scans as well as PET scans can be used but are not commonplace in the ED.

Author:  Russell Jones, MD

Image Contributor:  Zachary Skaggs

Advertisements
,

About emrems411

EMREMS: Radiology in Emergency Medicine

View all posts by emrems411

Subscribe to EMREMS

Subscribe to our RSS feed and social profiles to receive updates.

No comments yet.

Leave a Reply

Please log in using one of these methods to post your comment:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out /  Change )

Google+ photo

You are commenting using your Google+ account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s

%d bloggers like this: