Back
pain and infrarenal abdominal aortic aneurysm
(Portuguese
PDF version)
Telmo
P. Bonamigo,1 Nilon Erling Jr.,2 Marcela Salles3
1.
Adjunct professor of vascular surgery, Fundação Faculdade
Federal de Ciências Médicas de Porto Alegre (FFFCMPA).
Chief of the service of vascular surgery, Santa Casa de Misericórdia
de Porto Alegre, RS, Brazil.
2. Resident of vascular surgery, Santa Casa de Misericórdia
de Porto Alegre, RS, Brazil.
3.
Cardiovascular surgeon, service of cardiac surgery, Hospital São
Francisco, Santa Casa de Misericórdia de Porto Alegre, RS,
Brazil.
Correspondence:
Nilon Erling Jr.
Rua João Teles, 280/603
CEP 90035-120 - Porto Alegre, RS, Brazil
Phone: +55 (51) 3311.4381/9116.9019
E-mail: nilon.voy@terra.com.br
J
Vasc Br 2004;3(4):401-2
A 77-year-old
female patient, smoking, presented in the emergency room with intense
and sudden back pain at the level T11-T12. She was requested a lumbar
column x-ray and administered analgesic and non-steroid antiinflammatory
drugs (NSAIDS). After symptoms relief, she did not wait for the tests
findings and remained home with mild pain and continued intake of NSAIDS.
After 4
days, she presented a new event of intense pain at the same local and
returned to the emergency service. The ultrasound of the abdomen and
simple abdominal x-ray (Figure 1) revealed a 6-cm diameter abdominal
aortic aneurysm (AAA) with calcified walls. The first column x-ray had
already showed the calcified borders of the aneurysm. The patient was
then submitted to a computed tomography (CT) scan of the abdomen and
pelvis. The abdominal aorta was dilated since the thoracoabdominal transition
(Figure 2) and had an infrarenal aortic aneurysm with 6.5 cm diameter
(Figure 3), extending to the right iliac artery and with no signs of
rupture. Laboratory data revealed hemoglobin of 13.6 g/dl, creatinine
of 0.7 mg/dl and erythrocyte sedimentation rate of 60 mm in one hour.
Figure
1 - Abdominal x-ray with evidence of the calcified edge of the abdominal
aortic aneurysm (arrow).
Figure
2 - Abdominal computed tomography scan at the level of the left
renal vein showing the aorta slightly dilated.
Figure
3 - Abdominal computed tomography scan showing the infrarenal abdominal
aortic aneurysm.
A vascular
surgeon was then consulted.
Possible
questions:
- Which would be the possible causes of patient's lumbar pain?
- Would it be the infrarenal AAA revealed in the CT scan?
- Was pain location in compliance with the AAA position?
- Which could be the cause of pain, besides the AAA?
- Could it be an acute aortic dissection that did not advance beyond
the thoracoabdominal transition?
- Could it be a contained rupture in a dilated portion of the thoracic
aorta, once it was dilated in the thoracoabdominal transition?
