Case of the Month: May, 2011

Submitted by Christine Ghatan, MD and Marcel Maya, MD.

History: 13-year-old male presents to the ED with 2 weeks of progressively worsening low right-sided back pain. It is sharp, does not radiate, and worsens with palpation and lying down. He denies trauma to the area.

Of note, within the past month, he was diagnosed with presumed post-streptococcal glomerulonephritis and was started on a short course of steroids after presenting to his PMD with periorbital edema and fevers. However, urinalysis, BMP, CBC, and renal ultrasound were all unremarkable except for mild anemia. After his pain and fevers worsened, he developed leukocytemia with 80% PMNs, and his renal workup was negative, his nephrologist recommended he seek additional services at the Emergency Department.

Physical exam is significant for a temperature of 100.8 degrees. The patient has point tenderness to the right of his upper lumbar spine. There is no spinal deformity, nor are no muscle contractures or spasms, weakness, or problems with gait.

( Click here for larger image. )

Question: Can you identify an abnormality?

  1. Compression of L5 vertebral body.
  2. Abdominal free air.
  3. Pelvic mass.
  4. No abnormality identified.


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