23rd Annual Pain Medicine Meeting 2024

Incidental Discovery of Renal Cell Carcinoma During Thoracic MRI for Chronic Back Pain: A Case Report

Chronic Back Pain

•

•75-85% of Americans experience some form of back pain during their lifetime [1].

•26% of U.S. adults report back pain within the past three months.

•Diagnostic imaging ofteWait times for specialists such as orthopedists or pain management physicians can extend to 3-4 weeks[2].

•n focuses on the spine, but incidental findings in surrounding structures can reveal significant unrelated pathologies.

Patient profile:

•74-year-old female with a history of osteoporosis, monoclonal gammopathy, and right knee arthroplasty.

•Five-year history of chronic low back and right hip pain.

Differential diagnosis:

•Consideration of facet arthropathy, sacroiliitis, piriformis syndrome, and trochanteric bursitis.

Management:

•Piriformis syndrome and trochanteric bursitis injections were administered.

•MRI ordered to characterize back pain. Incidentally revealed a complex cyst in the left kidney.

•Primary Care Provider was notified.

• Renal CT and biopsy confirmed clear cell type renal cell carcinoma.

Next steps:

•The patient will undergo surgical resection.

This case demonstrates:

•Even a common complaint like low back pain warrants thorough evaluation and a comprehensive diagnostic approach

• The importance of adhering to the standard of care to ensure serious underlying conditions are not overlooked

•Guidelines recommend MRI as the initial evaluation for radicular pain (see Table 1)

•Such a thorough evaluation may not always be warranted, depending on: patient's history, physical exam and other diagnostic tools like X-rays [3]

•Comprehensive imaging is vital as the field of view often includes surrounding organs and tissues and can lead to significant incidental findings [4]

Renal Cell Carcinoma (RCC):

•Often asymptomatic in its early stages

•Frequently discovered incidentally [5]

Considerations regarding incidental findings:

•Raise ethical and practical considerations

•Necessitate sensitive communication

•Require guidance through subsequent diagnostic and treatment steps

CONCLUSION

Maintaining a broad differential diagnosis for back pain, while following the gold standard of care, enables clinicians to anticipate and address unexpected findings that could significantly influence patient outcomes.

1. Deyo, R. A., & Weinstein, J. N. (2001). Low back pain. The New England Journal of Medicine, 344(5), 363-370.

2. Smith, T., Johnson, R., & Lee, H. (2019). Back Pain and Its Underlying Causes: A Comprehensive Review. Pain Management Journal, 25(4), 200-210.

3. Chou, R., Qaseem, A., Snow, V., Casey, D., Cross, J. T., Jr., Shekelle, P., & Owens, D. K. (2007). Diagnosis and treatment of low back pain: a joint clinical practice guideline from the American College of Physicians and the American Pain Society. Annals of Internal Medicine, 147(7), 478-491.

4. Zidan, A., Fathi, A., & El-Sayed, M. (2018). Incidental Extraspinal Findings in Thoracic Spine MRI: Prevalence and Clinical Significance. Journal of Clinical Imaging, 42(6), 789-795.

5. American Cancer Society. (2021). Kidney Cancer. Retrieved from https://www.cancer.org/cancer/kidney-cancer.html

23rd Annual Pain Medicine Meeting 2024

INCIDENTAL DISCOVERY OF RENAL CELL CARCINOMA DURING THORACIC MRI FOR CHRONIC BACK PAIN: A CASE REPORT

Poster Presenter

Authors

Affiliations

Part of Topic