Abdominal Aortic Aneurysm as a Long Time Cause of Low Back Pain and Vertebral Scalloping

Abstract

A 47-year-old male smoker was referred to our outpatient clinic with slowly developing, continuous low back pain (LBP) and vascular claudiation in his lower extremities. LBP had persisted for 6 years. His back pain was insidious at onset, and the pain worsened with standing and walking. His complaints sometimes occurred even at rest, especially during lying down. He did not have any other signs of cardiovascular distress other than the fatigue. He has never sought help for his back pain. He reported no history of regular exercise. He had no history of major trauma. Medical history revealed hypertension. On physical examination, the neuro-muscular examination was normal. Arterial pulses for the lower limbs were normal. Palpation of the lumbar spinous process segments and erector spinae muscles were painful. Laboratory investigations (complete blood count, erythrocyte sedimentation rate, C-reactive protein) were within normal limits. Lumbar spine radiographs showed destruction of the anterior wall of the vertebral bodies of L3 and L4 ( Figure 1A). Computed tomography and magnetic resonance imaging showed a chronic contained rupture of an abdominal aortic aneurysm (AAA) ( Figure 1C-F) and aortic dissection ( Figure 1G). The lower aneurysm was eroding the anteroinferior margin of the L3 vertebra body extensively and the anterior margin of the L4 vertebra body. On consultation, the patient was treated with a graft by vascular surgeons and his back pain did improve after the surgery. Figure 1 Lateral X-ray image (A) showing a destruction of anterior wall of vertebral bodies of L3 and L4, and posteroanterior view (B) appears normal. MR imaging in T1 (C) and T2 (D) showing aneurysm in abdominal aorta, massive destruction L3 and L4 vertebral body. Sagittal (E) and axial (F) CT images show aneurysm of the abdominal aorta (white arrow) eroding L3 and L4 vertebral bodies (black thin arrow). (G) Axial CT imaging showing dissection of the aorta above the aneurysm sac (arrow).

Exposure of Pedicle Screws due to Chronic Vertebral Erosion by Tracheostomy Tube Cuff Balloon

“…In dural ectasia, ballooning of the thecal sac can result in characteristic posterior vertebral scalloping in Marfan's syndrome and neurofibromatosis 11,12 . There has also been a reported case of a chronic, contained abdominal aortic aneurysm rupture leading to extensive scalloped anterior erosion of the L3-L4 vertebrae in a patient with no underlying connective tissue disorder 13 . Moreover, disruption of blood flow by the cuff may have led to ischemic necrosis and chronic resorption of the vertebral bodies, additionally contributing to loss of bone volume.…”

Persistent low back pain reveals a massive non-ruptured aortic abdominal aneurysm: A case report

“…When it comes to clinical manifestations, AAAs are often asymptomatic and diagnosed as an incidentaloma [10]. AAAs represent an infrequent cause of low back [11,12].…”

Abdominal aortic aneurysms part one: Epidemiology, presentation and preoperative considerations

“…In a large study of 79,121 abdominal ultrasound, computed tomography (CT) and magnetic resonance imaging (MRI) scans, an incidental AAA was found in 1% of patients (Van Walraven et al 2010). When symptomatic, an unruptured AAA may present with a pulsating pain or sensation in the stomach or groin (Petriceks et al 2018) and/or a chronic lower back pain from vertebral column erosion (Yildizgoren et al 2016).…”