Presentation
Mobile fluctuating lump in the right lumbar region. Right leg pain. Spinal pain, radiating to the right.
Patient Data
The ultrasound study at the source of pain in the lower back on the right revealed a herniating and mobile lump. This was seen within the subcutaneous fat and had the same echogenicity and overall appearance of fat.
Therefore a tentative diagnosis of fat necrosis or intra-cutaneous fact herniation was made.
A dedicated MRI study was then undertaken.
MRI pelvis and lower back study to determine the site of herniation seen on the ultrasound study.
This reveals a subtle focus of edematous fat adjacent to the posterior superior iliac spine on the right and the fascial sheath of the paraspinal muscles.
In addition, this region demonstrates restricted diffusion on the DWI sequencing.
Otherwise, the study is unremarkable.
This coincides with the site of pain highlighted by the MRI skin markers.
Case Discussion
"Back mice" can be difficult to diagnose and are often missed. This patient had received many back pain investigations, including a full-body MRI.
However, no test had been diagnostic until the ultrasound study had revealed a definite mobile fat lump. Following this, the MRI confirmed the diagnosis. Again, MRI diagnosis being used to confirm back mice has been established 1.
Case presented with Mr. John Bayford DCRR (R) DMU
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