Open Access

Abdominal aneurysm diagnosed by plain radiograph

International Journal of Emergency Medicine20103:229

https://doi.org/10.1007/s12245-010-0229-1

Received: 10 October 2009

Accepted: 18 August 2010

Published: 28 October 2010

A 75-year-old male with a history of hypertension and diabetes presented with severe, progressive low back pain over the past 6 months after a fall. His examination was significant for tenderness to his lower back bilaterally, no abdominal tenderness, and a normal neurovascular exam. His vital signs were stable with a blood pressure of 168/97. A radiograph of his lumbar spine was obtained showing no acute injury, but a large saccular aneurysm (Fig. 1). A computed tomography scan was obtained showing an 8-cm abdominal aortic aneurysm (Fig. 2).
Fig. 1

(a) Oblique view of lumbar radiograph showing a saccular aneurysm (white arrows). (b) Lateral view of lumbar radiograph showing a saccular aneurysm (black arrows)

Fig. 2

Computed tomography scan showing an 8-cm aneurysm (white arrow)

Diagnosing an abdominal aortic aneurysm (AAA) can be challenging and requires a heightened sense of awareness. Most patients are asymptomatic, but can present with abdominal pain, groin pain or back pain [1]. While aneurysms over 5 cm are palpable on examination, 76% of the time, physical examination is not reliable in ruling out AAA [2].

Bedside ultrasound and computed tomography have been shown to be very accurate in diagnosing AAA. Plain radiographs have limited usefulness in the diagnosis of a ruptured AAA, with characteristic findings of calcified aneurysm, loss of psoas or renal outline, or renal displacement [2]. Treatment is based on stability as well as anatomical considerations. Recent advances utilizing endovascular repair have been shown to be as effective as open repair, with decreased complications associated with endovascular repair [3].

Authors’ Affiliations

(1)
Department of Emergency Medicine, Eastern Virginia Medical School; Emergency Physicians of Tidewater

References

  1. Upchurch GR, Schaub TA (2006) Abdominal aortic aneurysm. Am Fam Physician 73(7):1198–204PubMedGoogle Scholar
  2. Haro LH, Krajicek M, Lobl JK (2005) Challenges, controversies, and advances in aortic catastrophes. Emerg Med Clin North Am 23(4):1159–77PubMedView ArticleGoogle Scholar
  3. Schermerhorn ML, O'Malley AJ, Jhaveri A et al (2008) Endovascular vs. open repair of abdominal aortic aneurysms in the Medicare population. N Engl J Med 358(5):464–74PubMedView ArticleGoogle Scholar

Copyright

© The Author(s) 2010

This article is published under license to BioMed Central Ltd. Open Access This article is distributed under the terms of the Creative Commons Attribution Noncommercial License which permits any noncommercial use, distribution, and reproduction in any medium, provided the original author(s) and source are credited.

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