Differential Diagnosis for Tory Clark
- Single most likely diagnosis
- Osteoporotic compression fracture: This is the most likely diagnosis given the patient's history of chronic corticosteroid use, low BMI, smoking, and alcohol consumption, all of which are risk factors for osteoporosis. The sudden onset of severe lower back pain after lifting a heavy box, the presence of thoracic kyphosis, and the imaging findings of >35% loss of vertebral height and collapse at L4 are consistent with this diagnosis.
- Other Likely diagnoses
- Musculoskeletal strain: The patient's recent history of lifting a heavy box could also suggest a musculoskeletal strain, although the severity of the pain and the presence of a compression fracture on imaging make this less likely.
- Degenerative disc disease: The patient's age and history of back pain could also suggest degenerative disc disease, although the acute onset of pain and the presence of a compression fracture make this less likely.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Spinal cord compression: Although the patient does not have radiating pain or neurological deficits, spinal cord compression is a potential complication of a vertebral compression fracture that could have serious consequences if missed. An MRI with and without contrast has been recommended to evaluate for this possibility.
- Pathological fracture: Given the patient's family history of multiple myeloma, there is a possibility that the fracture could be pathological in nature, although this is less likely given the patient's history of osteoporosis and corticosteroid use.
- Infection (e.g. osteomyelitis or discitis): Although the patient does not have fever or other signs of infection, these conditions could present with back pain and would require prompt treatment to prevent serious complications.
- Rare diagnoses
- Multiple myeloma: Although the patient has a family history of multiple myeloma, this diagnosis is less likely given the patient's age and the presence of other risk factors for osteoporosis.
- Metastatic disease: The patient's history of smoking and alcohol consumption could increase the risk of certain types of cancer, although there is no other evidence to suggest metastatic disease at this time.