Hip Pain - Teenage Middle Eastern Refugee

HISTORY: Patient is a 10-year-old refugee presenting to the John Peter Smith (JPS) Family Health Clinic for his initial appointment after arriving from Afghanistan in April 2022. In May 2021, the patient began complaining to his parents of left hip pain and lower back pain. Initially, the parents tried to treat with medications. The family arrived to Texas for asylum processing. The camp physician was concerned and he was referred to a regional medical center. There they noted a mild leukocytosis, but negative x-rays of the left hip as well as negative MRI of the L hip. The family then came to North Texas where they established care with JPS. It was confirmed that the patient had mild scoliosis and a loud systolic murmur, but no other significant abnormalities. Subsequently, he was seen at a regional pediatric hospital for a scoliosis evaluation as well as worsening left hip and back pain. The pediatric orthopedist the patient had worsening range of motion of the lumbar spine and began to have weakness in the bilateral proximal thigh muscles. The surgeon recommended emergent evaluation. PHYSICAL EXAM: -Left Hip: no tenderness to palpation of the greater tuberosity, negative log roll test, positive FADIR and FABER-Right Hip: no abnormalities-Spine: right convexity noted of the lumbar spine with left convexity of the thoracic spine; mild kyphosis of the thoracic spine-Neuro: no weakness, parathesis or change in reflex noted in the upper or lower extremities DIFFERENTIAL DIAGNOSIS: 1.Juvenile Idiopathic Scoliosis2.Juvenile Idiopathic arthritis3.Slipped Capital Femoral Epiphysis4.Avascular Necrosis TEST AND RESULTS: -Xray Spine: 17 degrees of left thoracic scoliosis; 27 degrees of right lumbar scoliosis-MRI Spine: There is a well-circumscribed intradural extramedullary mass in the lower thoracic thecal sac extending between T10-T12 levels. There is severe right lateral displacement along with flattening of the thoracic spinal cord. The mass does not extend into the neural foramen. FINAL/WORKING DIAGNOSIS: -Intradural Extramedullary Spinal Tumor with pathology consistent with Schwannoma TREATMENT AND OUTCOMES: 1.Successfully had the tumor removed 2.Continues to deal with moderate scoliosis and care team is considering starting bracing 4.Walking without difficulty, no weakness or paresthesia