Metastatic small cell lung cancer to bone - false negative CT lumbar spine

Case contributed by Dr Chris O'Donnell

Presentation

Severe low back pain. Pre-op assessment for spinal fusion of bilateral L5 pars defects

Patient Data

Age: 65
Gender: Male

CT for low back pain shows chronic bilateral pars defects of L5 with anterior spondylolisthesis and secondary marked spondylarthritis at L5/S1. No abnormality seen in S1.

MRI performed as part of the pre-op workup by a spinal surgeon shows diffuse infiltration (replacement of normal bone marrow) of sacrum and left ilium with a pathological left ilial fracture presumed to be responsible for severe pain.

PET shows hyperglucose metabolism in the left hemipelvis and sacrum as well as multiple mediastinal and hilar lymph nodes, and left supraclavicular lymph nodes

Enlarged dysmorphic left nodes in left supraclavicular fossa biopsied under US control showing metastatic small cell carcinoma

Case Discussion

This study shows how insensitive CT can be for diffuse tumour infiltration of bone and highlights the fact that MRI is the investigation of choice for low back pain. CT should be limited to investigation of acute trauma to the lumbar spine and for confirmation of suspected bone lesions as initially seen on MRI.

PlayAdd to Share

Case Information

rID: 26580
Case created: 29th Dec 2013
Last edited: 18th Nov 2015
Inclusion in quiz mode: Included

Updating… Please wait.
Loadinganimation

Alert accept

Error Unable to process the form. Check for errors and try again.

Alert accept Thank you for updating your details.