A 48-year old female breast cancer survivor is admitted to the ED with chief complaint of upper lumbar pain described as an intermittent, variable, and dull ache without referral into the buttock or lower extremities. She had sought attention from her primary care physician but 10 sessions of Physiotherapy and NSAIDs failed to treat her. The pain is most intense in the evening and occasionally causes difficulty falling asleep. She also mentions an unintentional weight loss of 6 kg within the last two months. Presence of which of the following in the physical examination would justify ordering an Emergent MRI during this ED visit?

About the Author: Anton Helman

Dr. Anton Helman is an Emergency Physician at North York General in Toronto. He is an Assistant Professor at the University of Toronto, Division of Emergency Medicine and the Education Innovation Lead at the Schwartz-Reisman Emergency Medicine Instititute. He is the founder, editor-in-chief and host of Emergency Medicine Cases.