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[Clinical diagnosis and decision in practice. A young woman with back pain]
C van Weel1, A L Lagro-Janssen, H A Lagro
1Katholieke Universiteit, vakgroep Huisartsgeneeskunde, Nijmegen.
A woman aged 23 visited the GP because of nagging back pain at the level of L.2-L.3. In spite of the atypical symptom, the GP made the diagnosis of 'back pain of myogenic origin', possibly the result of camping in inclement weather. When the pain was still present after one week, the patient coughed, produced greyish-green mucus, was dyspnoeic, had 38.5 degrees C fever, while crepitations and reduced breathing sounds were heard in the right lower lung fields, the working diagnosis of 'pneumonia' was made. No laboratory studies were done; X-ray diagnostics and a good response to antibiotic treatment confirmed the diagnosis. After the symptoms recurred and patient's use of an oral contraceptive was established, she was examined for 'pulmonary embolism'. After this condition was shown to be likely, anticoagulant treatment was instituted, which led to rapid recovery.
A woman aged 23 visited the GP because of nagging back pain at the level of L.2-L.3. In spite of the atypical symptom, the GP made the diagnosis of 'back pain of myogenic origin', possibly the result of camping in inclement weather. When the pain was still present after one week, the patient coughed, produced greyish-green mucus, was dyspnoeic, had 38.5 degrees C fever, while crepitations and reduced breathing sounds were heard in the right lower lung fields, the working diagnosis of 'pneumonia' was made. No laboratory studies were done; X-ray diagnostics and a good response to antibiotic treatment confirmed the diagnosis. After the symptoms recurred and patient's use of an oral contraceptive was established, she was examined for 'pulmonary embolism'. After this condition was shown to be likely, anticoagulant treatment was instituted, which led to rapid recovery.