Wednesday, September 10, 2008

Very unusual cases of buttock and radiating lower extremity pain- examples


1. You JS reported a case of lumbosacral plexopathy caused by an isolated aneurysm in the common iliac artery.
S/S: a. The patient presented with low back and buttock pain radiating to the right leg and numbness in the L5 and S1 dermatomes.
Investigations: CT scan (abdomen)
2. Kakutani K reported radiculopathy due to malignant melanoma in the sacrum.
S/S: 52-year-old man who was admitted with increasing lower back, left buttock, and left lower extremity pain, and dysuria consistent with S1 radiculopathy
Investigations: Plain radiograph, CT scan, and MRI revealed a destructive lesion in the sacrum and left ilium, which infiltrated the spinal canal and sacroiliac joint. This case was also immunoreactive for HMB-45.
Caution: The incidence of primary melanoma is increasing faster than any other cancer. Melanoma is an interesting tumor, showing the appearance of metastasis without any trace of its primary lesion. The authors claim that malignant melanoma in the sacrum is a very rare case & S1 radiculopathy is reported for the first time
3. Perez A reported Infective Pyogenic Sacroiliitis.
S/S: a 4-year-old boy had a symptom triad of fever, buttock pain, and limping gait.
Investigations: MRI, Bone scan, blood & serum analyses for infection
Caution: extremely rare manifestations with nonspecific clinical presentation such as above; only 4 pneumococcal cases of infections are only reported. The therapeutic principles used in other osteoarticular infections.



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