Clinical Communication to the Editor|Articles in Press

Imaging Pitfalls, When We Should Trust Our Touch

Published:February 02, 2023DOI:
      A 37-year-old man with no significant past medical history was referred to the emergency department due to severe and sudden onset back pain. He also complained of weakness, nausea, and an episode of vomiting in the last 3 days. On examination he appeared ill with dry mucous membranes and poor skin turgor. He weighed 59 kg and had a height of 1.73 m (body mass index 19.7). He had a blood pressure of 130/80 mmHg, heart rate of 90 beats per min, temperature of 36.6 degrees Celsius, and O2 saturation of 99%. On palpation, marked tenderness was elicited over the right posterior aspect of the rib cage and small (up to 1 cm) but firm lymph nodes were palpated in the inguinal region bilaterally. Blood tests revealed hypercalcemia of 22.3 mg/dL and undetectable parathyroid hormone levels, creatinine of 1.6 mg/dL, urea of 63 mg/dL, and phosphorus of 4.4 mg/dL. He was treated with intravenous saline followed by furosemide, intravenous pamidronate and subcutaneous calcitonin. Adequate urine output was maintained, and serum calcium dropped to 13 mg/dL within 24 hours and to 10.1 md/dL within 3 days.
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