SLIDE QUIZE OF THE MONTH
CASE NO. B-0640/11 BSMMU
Male 45 years.
Chief complaints:
1. Abdominal distension and pain for 7 days.
2. Weakness in limbs and neck pain for 1 month
3. A few episodes of malena and fresh bleeding P/R and fever for 1 year.
Physical examination:
X-ray chest: right sided pleural effusion
Endoscopy of upper GI Tract: Normal
Haematological findings:
Male 45 years.
Chief complaints:
1. Abdominal distension and pain for 7 days.
2. Weakness in limbs and neck pain for 1 month
3. A few episodes of malena and fresh bleeding P/R and fever for 1 year.
Physical examination:
- Moderate anaemia
- Mild splinomegaly
- Weakness of limbs with exaggerated tendon reflexes
- No sensory deficit
- Marrow replaced in all spines
- Soft tissue mass extended to spinal canal through neural foramina at T2 to T5 (image in slide show)
- At C6-C7 and C7-T1 posterior bulge of IV disc noted without significant compression (image in slide show)
- Comment: Metastasis, multiple myeloma or lymphoma.
X-ray chest: right sided pleural effusion
Endoscopy of upper GI Tract: Normal
Haematological findings:
- Haemoglobin 7.7 gm/dl
- ESR 100 mm after 1st hour
- Neutrophils 76%
- Serum protein electrophoresis- polyclonal gammopathy
- Coomb’s test +ve (both direct and indirect)
- Increased tracer uptake in almost all joints
- Non homogenous tracer uptake throughout the spine, rib cage and long bones.
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