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Virtual Pediatric Hospital: Back Pain in Children: Case Examples of Back Pain in Children: Case 2 Back Pain in Children: Case Examples of Back Pain in Children

Case 2

Michael P. D'Alessandro, M.D.
Peer Review Status: Internally Peer Reviewed


Three year old female with a three week history of intermittent, worsening back pain, that eventually resulted in her refusing to walk. There was no history of trauma or infection. She had no fever and had a normal white blood cell count and sedimentation rate. Clinically she was felt to have a tumor.

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A percutaneous biopsy was performed to exclude a malignant process. The biopsy findings were compatible with Histiocytosis X.

Histiocytosis X is caused by an abnormal proliferation of histiocytes. The classic finding on plain radiographs is flattening of the vertebral bodies known as "vertebra plana," and lytic lesions. Around the vertebral bodies, a soft tissue paravertebral mass may be seen. Although the diagnosis may often be made from plain film, a bone scan is often performed to look for distant lesions, as there may be multiple lesions in cases of Histiocytosis X. Once a lesion is discovered, CT and MRI may delineate it better, if necessary.

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