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06 February 2015 : Case report  Spain

Misdiagnosis of Sacral Stress Fracture: An Underestimated Cause of Low Back Pain in Pregnancy?

Challenging differential diagnosis, Rare disease, Educational Purpose (only if useful for a systematic review or synthesis)

Ambar Deschamps PerdomoABDEF, Felix Tome-BermejoABEF, Angel R. PiñeraACDE, Luis AlvarezABDE

DOI: 10.12659/AJCR.892631

Am J Case Rep 2015; 16:60-64

Abstract

BACKGROUND: Sacral stress fracture during pregnancy is an uncommon condition with unclear pathophysiology, presenting with non-specific symptoms and clinical findings. To date, few cases have been published in the literature describing the occurrence of sacral stress fracture during pregnancy.

CASE REPORT: We report a 28-year-old primigravid patient who developed lumbosacral pain at the end of the second trimester. Symptoms were overlooked throughout pregnancy and the postpartum period, resulting in the development of secondary chronic gait and balance problems.

CONCLUSIONS: Stress fracture of the sacrum should be included in the differential diagnosis of low back and sacral pain during pregnancy. Its prevalence is probably underestimated because of the lack of specificity of the symptoms. Plain radiographs are not appropriate due to radiation exclusion; magnetic resonance is the only method that can be applied safely. There is limited information on natural history but many patients are expected to have a benign course. However, misdiagnosis may lead to prolonged morbidity and the development of secondary gait abnormalities. Stress fracture of the sacrum should be included in the differential diagnosis of low back and sacral pain during pregnancy. A high index of suspicion is necessary to establish an early diagnosis and appropriate treatment.

Keywords: Diagnosis, Differential, Diagnostic Errors, Fractures, Stress - diagnosis, Low Back Pain - etiology, Magnetic Resonance Imaging, Pregnancy, Pregnancy Complications, Sacrum - injuries, Spinal Fractures - diagnosis

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American Journal of Case Reports eISSN: 1941-5923
American Journal of Case Reports eISSN: 1941-5923