Publish in this journal
Journal Information
Vol. 14. Issue 5.
Pages 307-308 (September - October 2018)
Visits
...
Vol. 14. Issue 5.
Pages 307-308 (September - October 2018)
Images in Clinical Rheumatology
DOI: 10.1016/j.reumae.2017.02.008
Full text access
Abdominal Aneurysm: An Uncommon Cause of Low Back Pain
Aneurisma abdominal: una causa infrecuente de dolor lumbar
Visits
...
Álvaro García Martos
Corresponding author
alvarogarciamartos@gmail.com

Corresponding author.
, Marina de los Riscos Álvarez, Cruz Fernández-Espartero
Servicio de Reumatología, Hospital Universitario La Zarzuela, Madrid, Spain
Article information
Full Text
Bibliography
Download PDF
Statistics
Figures (1)
Full Text
Case report

We present the case of a 73-year-old man. His history of interest includes the absence of allergies to drugs. As cardiovascular risk factors, he had hypertension, diabetes mellitus, dyslipidemia and revascularized coronary artery disease with triple bypass. He had a pacemaker. He came to our department transferred by his general practitioner due to a 5-year history of mechanical low back pain, which, in the preceding 4 months had come to have a mixed rhythm that impeded him from sleeping at night. He was resistant to standard treatment with analgesics of the first and second steps of the World Health Organization pain ladder and nonsteroidal anti-inflammatory drugs.

In physical examination of his spine, we observed minimum scoliosis, negative pressure in the lumbar spine, limitation in flexion and extension in the final stages, with no other abnormalities, and a normal neurological examination. Plain radiology revealed lumbar scoliosis, minor listhesis of less than 20% of L5 over S1, with disk disease, vacuum phenomenon and posterior sclerosis suggestive of arthrosis. The abdominal aorta was calcified, with a considerable dilatation caused by an aneurysm measuring approximately 10cm in diameter (Fig. 1).

Fig. 1.

Anteroposterior and lateral radiographs of the lumbar spine. They show aneurysmatic dilation of the abdominal aorta labeled with a line that measures its transverse axis.

(0.13MB).

Given this finding, the patient underwent vascular surgery within the next 48h, with disappearance of the mixed low back pain. Urgent laboratory tests had been performed prior to the operation. They showed a hemoglobin level of 10.3g/dL, with normal mean corpuscular volume and mean corpuscular hemoglobin; platelet levels and coagulation studies were normal. We found nothing abnormal in the liver function. Serum creatinine was 1.3mg/dL.

We performed computed tomography of the lumbosacral spine, that showed bilateral spondylolysis in L5 with grade 1 anterolisthesis of L5 on S1. The remaining vertebral bodies had conserved alignment, height and morphology. The diagnosis was L5-S1 interapophyseal osteoarthritis with degenerative disk disease. We observed interbody fusion, vacuum phenomenon and subchondral sclerosis in endplates. Small left posterolateral protrusion that was in contact with the thecal sac. The patient underwent aortoiliac repair secondary to treatment of abdominal aneurysm.

Discussion

The abdominal aorta is the most common site of arterial aneurysms. Aneurysms can be asymptomatic. When symptoms are detected, the clinical approach depends on the site. Risk factors for rupture are tobacco use, hypertension, large size and presence of symptoms.1

The indication for surgical treatment in this patient was the large size of the aneurysm and the other risk factors, which implicated a high risk of rupture.2

As a conclusion, we should not overlook the causes of lumbar pain that is external to the spine. Low back pain can entail a severe underlying disease, and early treatment can improve the prognosis.

Ethical DisclosuresProtection of human and animal subjects

The authors declare that no experiments were performed on humans or animals for this study.

Confidentiality of data

The authors declare that they have followed the protocols of their work center on the publication of patient data.

Right to privacy and informed consent

The authors declare that no patient data appear in this article.

Conflicts of Interest

The authors declare they have no conflicts of interest.

References
[1]
T.M. Joergensen, K. Houlind, A. Green, J.S. Lindholt.
Abdominal aortic diameter is increased in males with family history of abdominal aortic aneurysm: results from the Danish VIVA-trial.
Eur J Vasc Endovasc Urg, 48 (2014), pp. 669-675
[2]
A. Dardik, J. Lin, T. Gordon, M. Williams, B. Perler.
Results of elective abdominal aortic aneurysm repair in the 1990's: a population based analysis of 2335 cases.
J Vasc Surg, 30 (1999), pp. 985-995

Please cite this article as: García Martos Á, de los Riscos Álvarez M, Fernández-Espartero C. Aneurisma abdominal: una causa infrecuente de dolor lumbar. Reumatol Clin. 2018;14:307–308.

Copyright © 2017. Elsevier España, S.L.U. and Sociedad Española de Reumatología y Colegio Mexicano de Reumatología
Idiomas
Reumatología Clínica (English Edition)

Subscribe to our newsletter

Article options
Tools
es en

¿Es usted profesional sanitario apto para prescribir o dispensar medicamentos?

Are you a health professional able to prescribe or dispense drugs?

es en
Política de cookies Cookies policy
Utilizamos cookies propias y de terceros para mejorar nuestros servicios y mostrarle publicidad relacionada con sus preferencias mediante el análisis de sus hábitos de navegación. Si continua navegando, consideramos que acepta su uso. Puede cambiar la configuración u obtener más información aquí. To improve our services and products, we use "cookies" (own or third parties authorized) to show advertising related to client preferences through the analyses of navigation customer behavior. Continuing navigation will be considered as acceptance of this use. You can change the settings or obtain more information by clicking here.