Sacral insufficiency fractures: a case of mistaken identity

Sacral insufficiency fractures are an important cause of lower back pain in the elderly. Clinically and radiologically, they must be distinguished from osseous metastases, which frequently coexist. To date, no case report has comprehensively explored the full range of diagnostic hurdles and potentia...

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Bibliographic Details
Published in:International medical case reports journal 2014-01, Vol.7 (default), p.93-98
Main Authors: Baldwin, Mathew J, Tucker, Laura J
Format: Article
Language:English
Subjects:
Back pain
Biomechanics
Breast cancer
Case Report
Case reports
Case studies
Clinical outcomes
Edema
Family medical history
Fractures
Medical imaging
Metastasis
NMR
Nuclear magnetic resonance
Osteoporosis
Patients
Radiation therapy
Rheumatoid arthritis
Stress fractures
Trauma
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Summary:Sacral insufficiency fractures are an important cause of lower back pain in the elderly. Clinically and radiologically, they must be distinguished from osseous metastases, which frequently coexist. To date, no case report has comprehensively explored the full range of diagnostic hurdles and potential pitfalls. We report the case of a 70-year-old Caucasian female who presented to our services with a short history of progressive back pain without any history of trauma. A prior history of breast cancer was noted. Bone scintigraphy was initially reported as consistent with metastatic sacral deposits. Further characterization with magnetic resonance imaging and computed tomography revealed bilateral insufficiency fractures of the sacral alar. The patient responded well to conservative management. To avoid misdiagnosis, particularly in those who are also at risk of osseous metastases, sacral insufficiency fractures must always be considered as a cause of lower back pain.
ISSN:1179-142X
1179-142X
DOI:10.2147/IMCRJ.S60133