A diagnostic approach

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A summary of the safety diagnostic model is presented in Table 34.1 Table 34.1 Thoracic back pain: diagnostic strategy model

Q. Probability diagnosis

A. Musculoligamentous strains (mainly postural) vertebral dysfunction Q. Serious disorders not to be missed

Cardiovascular

myocardial infarction

• dissecting aneurysm

• pulmonary infarction Neoplasia

A • lung (with infiltration) A. • metastatic disease Severe infections

• infectious endocarditis

• osteomyelitis Pneumothorax Osteoporosis

Q. Pitfalls (often missed)

Angina

Gastrointestinal disorders

• oesophageal dysfunction

peptic ulcer (penetrating)

• hepatobiliary

• pancreatic A. Herpes zoster

Spondyloarthropathies Fibromyalgia syndrome Polymyalgia rheumatica Chronic infection

• tuberculosis

• brucellosis

Q. Seven masquerades checklist

Depression x

Thyroid disease

Spinal dysfunction xx

UTI x

Q. Is this patient trying to tell me something?

A. Yes, quite possible with many cases of back pain.

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