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Mid Back Lump - Coggle Diagram

- - - - Potts disease
        
        Risk factors
        
        Overcrowded, poorly ventilated living conditions.
        
        Living in TB-endemic area (Indonesia).
        
        Smoking (1 pack/day for 15 years).
        
        Close contact with a sibling who has prolonged cough (possible TB carrier).
        
        Pathophysiology
        
        Tb infection
        
        Latent tb
        
        Activation
        
        Extrapulmonary tb (tertiary)
        
        1 more item...
        
        Treatment & management
        
        Pharmacologic (Anti-TB Therapy - ATT):
        Rhze 2months rh 4 months
        Extended to 9-12 months for potts
        
        Supportive Therapy:
        Nutritional support (high protein, vitamins D & B6, calcium).
        Pain management.
        Bracing (short-term) to support unstable spine.
        Physical therapy (isometrics → strength/posture rehab
        
        Surgical Management (if indicated):
        Neurological deficit, spinal instability, severe kyphosis (>60°), or failure of medical therapy.
        Debridement, abscess drainage, spinal stabilization.
        
        General Practitioner Role (3A Competency in Indonesia):
        Diagnose and initiate treatment.
        Refer to orthopedic and rehabilitation specialists for comprehensive care.
        
        Prevention & education
        
        Prevention
        
        BCG Vaccination (infancy – reduces risk of severe TB forms).
        Early treatment of pulmonary TB to prevent hematogenous spread.
        Infection control measures:
        
        Education
        
        Recognize early TB signs: chronic back pain, weight loss, night sweats.
        Complete TB treatment course to prevent resistance or recurrence.
        Reduce stigma to encourage early care seeking.
        Promote hygiene, nutrition, and adequate ventilation at home.
        
        Prognosis & complications
        
        a. Prognosis:
        Favorable with early diagnosis and complete anti-TB treatment.
        Most patients achieve microbiological cure and structural stabilization.
        Delayed treatment → permanent deformities or neurologic deficits.
        Children: risk of deformity progression due to growth after healing.
        
        Neurological Deficits – due to spinal cord or nerve root compression.
        
        Spinal Instability – due to vertebral destruction.
        
        Kyphotic Deformity – gibbus formation, may impair function/cosmesis.
        
        Systemic Spread of TB – potential for multifocal or miliary TB
        
        Main diagnosis
        
        Patients history
        
        Tubercullin skin test (mantoux) 17mm
        
        Gibbus deformity
      - Reason for consideration: Presents with fever, back pain, and possible abscess formation.
        Reason for unlikelihood:
        More acute onset than TB.
        Patient lacks signs of sepsis or leukocytosis (normal WBC).
    - - Reason for consideration: Back pain, systemic signs of infection, tender spinal mass.
        Reason for unlikelihood:
        No neurological deficits.
        No signs of acute infection like fluctuant mass or elevated leukocytes.
  - - - Reason for consideration: Can present with back pain and spinal deformity.
        Reason for unlikelihood:
        No history of trauma.
        Chronic progression not typical of fractures.
    - - Reason for consideration: May cause deformity and back pain.
        Reason for unlikelihood:
        Patient lacks trauma history.
        Neurological signs absent.
  - - - Reason for consideration: Presents with chronic back pain, kyphosis, and systemic symptoms (weight loss, fatigue).
        Reason for unlikelihood:
        No known history of primary malignancy.
        Patient is relatively young (30 years old) — uncommon age for metastasis.
    - - Reason for consideration: Deep soft tissue mass possible in the back, especially retroperitoneally.
        Reason for unlikelihood:
        Usually painless until late stages.
        Systemic symptoms like night sweats and fever are rare in liposarcoma
  - - - Reason for consideration: Presents with back stiffness, worsens at rest, HLA-B27 association.
        Reason for unlikelihood:
        Pain improves with rest (opposite of typical AS).
        No mention of morning stiffness or sacroiliac involvement.
    - - Reason for consideration: Can involve the spine and cause deformities.
        Reason for unlikelihood:
        Typically affects cervical spine, not thoracic.
        No joint pain, stiffness, or autoimmune markers mentioned.
  - - - Reason for consideration: Can cause chronic back pain and visible spinal lump.
        Reason for unlikelihood:
        No vertebral slippage seen on imaging.
        No history of chronic mechanical back pain or neurological symptoms.
    - - Reason for consideration: Common cause of back pain.
        Reason for unlikelihood:
        No radiating pain or neurological deficits.
        No relief from supine position, which usually alleviates HNP discomfort.
        )