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Pediatric back pain (answer)…

March 7, 2014

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Several days ago I presented an early teenage patient with back pain:

ES of spine 1 ES spine 2

This patient has an osteolytic lesion at T11 which was later biopsied and found to be Ewing’s Sarcoma of the spine.  Roughly 10% of Ewing’s Sarcoma will primarily present in the spinal column.  Pediatric spinal column tumors are very rare but should be kept on the differential diagnosis of pediatric back pain.  Unlike adults, pediatric patients rarely present to the ED with the chief complaint of back pain.  Pyelonephritis and acute trauma are the leading pathology but malignancy should be explored if the clinical scenario is worrisome (weight loss, night sweats, neurologic signs, or unrelenting pain over weeks/months, central spinal tenderness). 

For more information on Ewing’s Sarcoma of the spine here is a summary article from Skeletal Radiology:

Ilaslan H, et al.  Primary Ewing’s sarcoma of the vertebral column.  Skeletal Radiol 2004 Sep; 33 (9): 506-13.

Author:  Russell Jones, MD

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Pediatric back pain…

March 3, 2014

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Early teen presents with back pain for several months…

ES of spine 1

ES spine 2

This thoracic spine series shows a loss of vertebral height at T11 and an indistinct right pedicle of T11.  What could cause this in an early teenager?  There was no history of trauma.

Answer to follow.

Author:  Russell Jones, MD

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Lumbar mets and fracture…

December 27, 2013

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Elderly male came in with acute onset pain in lumbar spine.  He indicentally has had weight loss over the past 6 months, about 40 lbs:

Path Fx L Spine 2 Path Fx L spine

This patient has a pathologic compression fracture of L1 vertebral body.  Also demonstrated are sclerotic lesions in L4 without a fracture. 

What is the most likely primary lesion?

Author:  Russell Jones, MD

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