Severe lumbar pain in an adolescent due to idiopathic vena cava thrombosis: a case report

BACKGROUND

Lumbar back pain in an adolescent is generally musculoskeletal, that is, due to a muscle strain or scoliosis. This case describes a young individual without any previous health issues who rapidly developed a life-threatening condition, though initially presenting with "only" back pain.

CASE PRESENTATION

A 16-year-old Caucasian male patient was admitted twice to the emergency department with debilitating lumbar pain without neurological or vascular symptoms. Imagery showed an extensive thrombosis of the inferior vena cava. No external cause, structural abnormality, or any systemic disease were found that predisposed the patient to this highly unusual vaso-occlusive incident.

CONCLUSION

Thrombosis of the inferior vena cava is a rare but life-threatening entity. It is underrecognized and associated with serious short- and long-term morbidity and mortality. Increased awareness is essential because deep vein thrombosis in children seems to cause atypical symptoms, such as spinal pain or the absence of edema of the lower limbs, as in the present case.

Relationship between energy cost, gait speed, vertical displacement of centre of body mass and efficiency of pendulum-like mechanism in unilateral amputee gait

The energy cost of gait (C) is greater in amputee than in normal subjects. Our objective was to assess the influence of lower speed, inefficient pendulum mechanism and disturbed smoothness of centre of body mass (CM(b)) displacement on C in unilateral amputees and to have a better understanding the relationship between these variables. Twelve adult patients (six traumatic transfemoral and six vascular transtibial amputees) participated in the study. Lower limb kinematics, displacement of CM(b), mechanical work done by the muscles to move the CM(b) and the segments due to their movements relative to the CM(b), efficiency of the pendulum mechanism, and C were assessed simultaneously in the 12 amputees walking at their self-selected speed. Our results show that C depended on gait speed, and efficiency of pendulum-like mechanism of walking but did not depend on the smoothness of CM(b). The use of only a single variable to explain the extra cost in amputee gait could sometimes be misleading.

Unusually prolonged course of tuberculous dactylitis with osteitis

We report a case of tuberculous dactylitis that was unusual in two regards: the bone was infected, and the course was prolonged and atypical, with a spontaneous clinical remission followed by a recurrence that led to the diagnosis.