RESUMO
In two women aged 85 and 62 years respectively, with pain in the lower back and the hip region, insufficiency fractures of the sacrum were diagnosed. They were treated by bed rest and pain medication with good clinical outcome. Especially in older, postmenopausal women who have been treated for a malignancy (possibly with irradiation of the pelvis), the possibility of sacral insufficiency fractures should be kept in mind. Many unnecessary and sometimes invasive investigations to exclude tumour or metastases can be avoided by adequate diagnostic imaging: first conventional X-ray investigation followed by skeletal scintigraphy. A typical H-shaped pattern of sacral uptake is diagnostic of insufficiency fractures. As this pattern is seen in only approximately 20% of the patients, additional CT will often be necessary. CT can demonstrate the fracture lines and exclude bone destruction or a soft tissue mass. In case CT is not conclusive MRI is indicated.
Assuntos
Fraturas Espontâneas/diagnóstico , Fraturas Espontâneas/terapia , Dor Lombar/etiologia , Sacro/lesões , Idoso , Idoso de 80 Anos ou mais , Anti-Inflamatórios não Esteroides/uso terapêutico , Repouso em Cama , Diagnóstico Diferencial , Feminino , Fraturas Espontâneas/etiologia , Humanos , Imageamento por Ressonância Magnética , Pessoa de Meia-Idade , Neoplasias/complicações , Osteoporose/complicações , Medronato de Tecnécio Tc 99m , Tomografia Computadorizada de Emissão/métodos , Resultado do TratamentoRESUMO
STUDY DESIGN: This is a case report of a patient with two giant cell tumors, the first in thoracic spine and the second, two years later, in the sacrum. OBJECTIVES: To report the first patient in whom multifocal primary giant cell tumors have been found in the spine. SUMMARY OF BACKGROUND DATA: There have been no similar previous reports. METHODS: The diagnoses were made by biopsy. RESULTS: Curative removal of both tumors was achieved. CONCLUSIONS: More than one primary giant cell tumor in the spine can develop.
