This is a lateral Xray showing part of the Spine of 68 year old  man who came to the Orthopedic Clinic complaining  of  back pain over the lumbo sacral area.In  addition to the lower back pain he was also complaining of generalized body weakness and diffuse type of headache also.During last 6 months of period he has been suffering from recurrent lower respiratory  tract infections and he was  treated for that.
On examination he was  ill loking and pale.No Lower limb muscle wasting,weakness or sensory impairement.

Comment  On this Xray?
What are the differential Dx in this patient?
What are the Investigations you  would like to do in this patient to come to the defenitive Diagnosis?



  1. nitin Says:
  2. i think it could be spinal tuberculosis secondary to pulmonary tb.

  3. Anonymous Says:
  4. arash from iran
    x.ray:vertebral fracture
    DDx : pathologic fracture , multiple myeloma , metastasis ,tuberculosis,brucellosis ,vertebral osteomyelitis ,
    workup: ESR , CXR , sputum culture , skull x ray for R/o punch out lesion , protein electrophoresis , sputum acid fast, IgM IgG for brucellosis
    my first diagnosis is multiple myeloma

  5. Hillis Says:
  6. The patient has a history of recurrent lower respiratory tract infection..Why? Does he has low immunity suspecting him to recurrent infection ? or was treating improperly ??.. More history should be taken from the patient.. Am thinking about osteomyelitis or spinal tuberculosis ..Investigation should be done to confirm the diagnosis
    Blood cultures ,Bone biopsy , Bone scan
    Bone x-ray
    C-reactive protein (CRP)
    Erythrocyte sedimentation rate (ESR)
    Needle aspiration of the area around affected bones.

  7. Anonymous Says:
  8. like multiple myeloma

  9. Azhar Says:
  10. It is vertibral collapse due to multiple myeloma

  11. Anonymous Says:
  12. Punched out lesions on spine...
    Dx:Multiple myloma

  13. Anonymous Says:
  14. does M.M affect just one vertebra !!??

    TB or osteomyeltis are closer

  15. Anonymous Says:
  16. Maybe Osteomyelitis or infection of both vertebral body and the disc. Maybe there is a recurrent pulmonary infection (COPD may be the underline cause) and subclinical bacteriemia cause this chronic problem. This spot is common of bacterial settling in the mode of subclinical bacteriemia in elderly people.

  17. compression # of L2 vertebra,osteopenia.
    D/D:multiple myeloma
    X-ray skull,pelvis
    urine Bence Jones protien
    plasma electophoresis

  18. Anonymous Says:
  19. arash from iran
    tell us diagnosis , i am anxious i am right ro not

  20. Anonymous Says:
  21. arash from iran
    what is diagnosis?

  22. Anonymous Says:
  23. you can find the diagnosis here

  24. Anonymous Says:
  25. Prostate CA vs Multiple myeloma

  26. Anonymous Says:
  27. dr_islam _ sudan

    There is osteolytic lesions of spine.
    Multiple myloma, secondaries(ca prostate), pott's disease.
    Protine electrophoresis is important.


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