Case:Leg Pain 001: Difference between revisions
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He does not have any current back pain. He has also been getting dystonia in the bilateral hands and fingers over the past few months. He has had an intentional weight loss of 10kg | He does not have any current back pain. He has also been getting dystonia in the bilateral hands and fingers over the past few months. He has had an intentional weight loss of 10kg | ||
'''PMHx''' | '''PMHx''' | ||
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*Hypertension | *Hypertension | ||
*Hyperlipidaemia | *Hyperlipidaemia | ||
*Atrial fibrillation | |||
*Coronary angiogram 3 years ago showing trivial coronary artery disease only | |||
*Gout | |||
'''Medications''' | |||
*Aspirin 100mg daily | |||
*Dabigatran 150mg twice daily | |||
*Furosemide 40mg mane | |||
*Metoprolol 71.25mg daily | |||
*Lisinopril 40mg daily | |||
*Spironolactone 25mg daily | |||
*Atorvastatin 40mg daily | |||
*Allopurinol 300mg daily | |||
'''Social history''' | '''Social history''' | ||
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=Imaging 1= | =Imaging 1= | ||
The referring doctor previously organised the below x-ray of his pelvis and hips | |||
<gallery mode=packed heights=250px> | |||
File:Leg pain case 001 pelvis AP.png | |||
File:Leg pain case 001 L hip lateral.png | |||
</gallery> | |||
{{Collapsible textbox | |||
|title=Pelvis and Left Hip Radiograph Report | |||
|text= There is slight cartilage space narrowing posteromedially in both hips not associated with any marginal spur formation. Cartilage space is preserved superiorly. Remainder of the bony pelvis and the sacroiliac joints are normal. | |||
}} | |||
<br> | |||
=Imaging 2= | |||
You refer him for an MRI of his lumbar spine to query spinal stenosis | You refer him for an MRI of his lumbar spine to query spinal stenosis | ||
<gallery mode=packed heights=350px> | |||
File:Leg pain case 001 MRI Lumbar Spine Sagittal Median.jpg|Sagittal Median | |||
File:Leg pain case 001 MRI Lumbar Spine Sagittal Paramedian.jpg|Sagittal Paramedian left | |||
File:Leg pain case 001 MRI Lumbar L4-5 Transarticular.jpg|L4-5 Transarticular | |||
</gallery> | |||
{{Collapsible textbox | {{Collapsible textbox | ||
|title=MRI Lumbar Spine Report | |title=MRI Lumbar Spine Report | ||
|text= | |text= | ||
*Five lumbar type vertebrae in normal alignment. ย | *Five lumbar type vertebrae in normal alignment. ย | ||
*No central spinal canal stenosis | |||
*Mild disc disease with Schmorl's nodes are seen at L1/2 and L3/4 and L4/5. At L1/2 and L2/3 no focal disc protrusion neural compromise or foraminal narrowing is seen. ย | *Mild disc disease with Schmorl's nodes are seen at L1/2 and L3/4 and L4/5. At L1/2 and L2/3 no focal disc protrusion neural compromise or foraminal narrowing is seen. ย | ||
*At L3/4 there is minor bulging of the disc annulus with a shallow left paracentral bulge but without neuralย compromise or foraminal narrowing there is mild facet | *At L3/4 there is minor bulging of the disc annulus with a shallow left paracentral bulge but without neuralย compromise or foraminal narrowing there is mild facet disease. ย | ||
disease. ย | *At L4/5 left sided annular tear. There is left lateral recess stenosis with mild neural contact, but no neural compression. There are small facet effusions with mild facet disease. ย | ||
*At L4/5 | *At L5/S1 no focal disc protrusion neural compromise or foraminal narrowing is seen. There is moderate hypertrophic facet disease. No abnormal bone marrow or soft tissue oedema is seen. ย | ||
*At L5/S1 no focal disc protrusion neural compromise or foraminal narrowing is seen. There is moderate hypertrophic facet disease. No abnormal bone marrow or soft | *The visualised SI joints are unremarkable. | ||
tissue oedema is seen. ย | |||
*The visualised SI joints | |||
*Conclusion: L4/5 left lateral recess stenosis contacting the descending left L5 nerve root but no compression. | *Conclusion: L4/5 left lateral recess stenosis contacting the descending left L5 nerve root but no compression. | ||
}} | }} | ||
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You bring him back in for a vascular examination and ankle brachial pressure index (ABPI) measurement | You bring him back in for a vascular examination and ankle brachial pressure index (ABPI) measurement | ||
''' | '''Vascular examination''' | ||
* left side:ย unable to feel femoral, popliteal, DP or PT pulses | * left side:ย unable to feel femoral, popliteal, DP or PT pulses | ||
* right side: weak femoral pulses, can't feel popliteal, weak DP and PT pulses | * right side: weak femoral pulses, can't feel popliteal, weak DP and PT pulses | ||
{| class="wikitable" | |||
ย | |+ ABPI | ||
|- | |||
!ย !! Right !! Left | |||
|- | |||
|Brachial||122||122 | |||
|- | |||
| DP|| 110|| 96 | |||
|- | |||
| PT|| 158|| 96 | |||
|- | |||
| ABPI|| 1.29|| 0.78 | |||
|} | |||
=Imaging | =Imaging 3= | ||
You refer him to vascular surgery who organise an MRI angiogram | You refer him to vascular surgery who organise an MRI angiogram | ||
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=Management= | =Management= | ||
Left distal CIA stenosis treated with 8mm Shockwave IVL and 9 x 59 Omnilink | Left distal CIA stenosis treated with 8mm Shockwave IVL and 9 x 59 Omnilink Elite stent | ||
Elite stent | |||
He is doing much better | |||
{{Header tabs}} | {{Header tabs}} | ||
[[Category:Case Histories]] | [[Category:Case Histories]] |