Nonspecific but Significant

Vague signs should not be overlooked, as they can on occasion, hint at a dire diagnosis. A 24-year-old serviceman complained about mild lower-back pain about 1 year before admission to our hospital. Initially, he visited an orthopedist, and plain radiography of the lateral thoracic and lumbar spine was performed. Several small irregularly-shaped calcifications located over the peritoneal region were interpreted as a nonspecific finding (Figure 1).

Six months before admission, he developed persistent epigastralgia. He was evaluated by a gastroenterologist, and esophagogastroduodenoscopy showed no obvious abnormal findings. Several small, irregular, sand-like calcifications superimposed over the left-lower area of the upper quadrant of the abdomen were again interpreted as nonspecific; no interval change occurred over the duration of the 6-month period before admission (Figure 2). Nevertheless, the pain intensity gradually continued to increase.

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-- Yu-Guang Chen, MD, Woei-Yau Kao, MD, PhD, Shih-Hung Tsai

This article originally appeared in the May 2012 issue of the The American Journal of Medicine.