Pictures of the Week

[lobelsteve]

7 years of back pain. Worse in last 3 months. Xray negative. Started getting weaker in thighs. No B/B.

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[Orin]

7 years of back pain. Worse in last 3 months. Xray negative. Started getting weaker in thighs. No B/B.

View attachment 386523

What did they read that as? Did it get better with steroids? It looks maybe like a vascular malformation or cancer with associated edema

 

[Dr. Ice]

T1-2 tfesi. foraminal hnp. Min relief with interlam. Mapped path/angle carefully on mri to avoid ptx…. Love my new c arm…. Oec 9900

So..they will get 2 weeks of relief with dex?

 

[lobelsteve]

What did they read that as? Did it get better with steroids? It looks maybe like a vascular malformation or cancer with associated edema

Intradural/extramedullary. Schwannoma. Surgical pathology confirmed.

 

[Taus]

So..they will get 2 weeks of relief with dex?

Potentially, but worth trying before sending to surgeon imho. Already did interlam w depo.

 

[MitchLevi]

Sucks...

 

[bedrock]

Sucks...

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Damn. What’s their Neuro exam like ?

 

[MitchLevi]

Damn. What’s their Neuro exam like ?

WC-bound paraplegic.

 

[geauxg8rs]

Sucks...

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L4/5 looks nice and well hydrated though. At least that’s something

 

[lobelsteve]

WC-bound paraplegic.

Probably the T12-L1 Modic changes. It’s vertebrogenic pain.

 

[runfastnow]

Never seen a sacral fx quite like this one. Two weeks out.
43 F. CT negative for cancer, mets, etc. Starting osteoporosis work up. Multiple surgeons don't have any answers or don't want to touch her.
Does anyone have any suggestions for interventions that might help? Trying to get her to get that giant poop out is project #1 since she hasn't gone in 6-7 days.

 

[SSdoc33]

Never seen a sacral fx quite like this one. Two weeks out.
43 F. CT negative for cancer, mets, etc. Starting osteoporosis work up. Multiple surgeons don't have any answers or don't want to touch her.
Does anyone have any suggestions for interventions that might help? Trying to get her to get that giant poop out is project #1 since she hasn't gone in 6-7 days.

View attachment 386907

i also wouldnt touch this.

 

[Ducttape]

this might be a rare indication for long term opioids. sacral fractures can take a year to get better.

butrans patch for a year.

suggest Relistor or Movantik for the constipation if that is due to OIC. SQ if you feel the need to initiate faster...

 

[BobBarker]

That is a huge poop. Looks like she needs a manual.

 

[SSdoc33]

That is a huge poop. Looks like she needs a manual.

 

[SSdoc33]

im gonna use this pic as much as possible. its perfect for whenever doctodd starts trolling

 

[lobelsteve]

I would ask orthopedic trauma surgeons to take a look. S3 fracture looks like it could use a reduction and percutaneous screws from caudal to cranial one on each side.