A 16 year old white girl was referred to a children’s spine clinic because of concerns about a mild scoliosis. On questioning, however, her main concern was a one year history of left sided mid-lumbar back pain. She would be woken up at night by her pain. The patient denied any history of trauma and had no history of systemic symptoms or any relevant past medical history. Her symptoms were such that she took regular ibuprofen tablets, which gave her symptomatic relief.

Physical examination revealed a mild right convex thoracolumbar scoliosis. Forward flexion of spine was painful. There was no distal neurological deficit. Systemic examination did not reveal any other abnormalities.

The results of the following blood tests were normal: full blood count, erythrocyte sedimentation rate, C-reactive protein, bone biochemistry profile, and rheumatoid profile.

A plain radiograph (fig 1), static bone scan (fig 2), and a computed tomogram (fig 3) show a skeletal abnormality, confirming the primary differential diagnosis.

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Figure 1

 Plain radiograph.

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Figure 2

 Static bone scan.

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Figure 3

 Computed tomogram.

QUESTIONS

1. What abnormalities are seen on the radiological investigations?

2. What is the likely diagnosis and how does it usually present?