non small cell lung cancer detected by non traumatic low back pain less than 2 weeks
Non traumatic Low back pain (LBP) is one of the commonest complain in emergency department. The most of non-traumatic LBP cases are easy to treatment and management but sometime is sign for a killer disease. Common is common but rare is found. In our practice we deal to many cases of non-traumatic LBP. The simple LBP is the commonest case, also we found other cases of serious disease which presented as non-traumatic LBP . This is the challenge of emergency physicians to detect the dangerous disease which presented as non-traumatic LBP. a many studies about non traumatic low back pain but some of this studies may the cause of mask the serious disease which presented as non-traumatic LBP . For example, some of this studies suggested no need of image for non-traumatic LBP until 6 to 8 weeks after the onset(1) . Unfortunately, we found some dangerous diseases presented as non-traumatic LBP and the patient became dead one or two week after the onset
A male patient 41 years old Indian gentleman presented with non-traumatic low back pain from 2 weeks back, 3 days back he cannot walk well . Normal muscle tone in both lower limbs. NO pain referred to the lower limbs . NO sign of cord compression: no urine incontinence, he can controlled the defecation and he denies any numbness or tingling in both lower limb . His vital signs were stable. No history of fever or cough. Patient had x ray from privet clinic that showed: osteolytic lesion in Lumbar 3,4 and 5 . X ray has been repeated in our ED and showed the same result as the previous one. The CT scan showed osteolytic lesion at Dorsal 12 , Lumbar 3,4and 5 with suggestion of TB or metastatic boney lesion . The patient has been admission by medical team after orthopedic consultation . The MRI showed: extensive pathological marrow infiltration of the vertebral column with impression of metastatic deposit .The pathological report mentioned: moderately differentiated metastatic adenocarcinoma. The lung would be high on list of possibility , however thyroid , pancreas and Bellary tract cannot be exclude . The patient was under care of orthopedic and oncology teams. On file review, no history of co morbidity only bronchial asthma from 2 years back. He diagnosed as non-small cell lung cancer.
