Aortic Flap Valve Presenting as Neurogenic Claudication

Lakdawala, Riaz Hussain; Rahmat, R.; Tan, Lenny; Wong, Hee-Kit

doi:10.1097/01.brs.0000109763.77854.9b

Cited by 4 publications

(2 citation statements)

References 11 publications

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“…The final studies included were case reports or series. Eighteen reports referred to abdominal conditions that mimic spinal diseases ( Table 1 ), 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 among them a patient with cyclic lumbar back pain who received a lumbar spinal fusion who, after persisting symptoms led to further diagnostic procedures, was ultimately diagnosed with endometriosis. 15 Spinal symptoms included paraplegia and urinary incontinence as results of acute aortic pathologies.…”

Section: Literature Review and Discussionmentioning

confidence: 99%

Lumbar Spondylodiscitis Mimicking Cholecystitis: A Case Report and Review of Literature

Mirbagheri

Etminan

Schölch

et al. 2022

J Neurol Surg A Cent Eur Neurosurg

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Background and Objective: Lower back pain is a frequent cause of Emergency Department visits and one of the leading causes of the disease burden worldwide. The purpose of this case report and literature review was to discuss atypical abdominal entities mimicking spinal diseases typically presenting with lower back pain. Patient and Methods: A 79-year-old male presented with lower back pain and urinary incontinence after receiving a non-image-guided lumbar infiltration treatment four weeks prior to admission. The MRI highlighted multi-segmental hyperintensities in the intervertebral disc spaces of the lumbar spine indicative for spondylodiscitis. Antibiotic treatment over a week did not lead to significant clinical improvement. Blood cultures, cardiologic, otorhinolaryngologic and dental examinations turned out negative for a focus of infection. A CT-guided biopsy was indicated after discontinuation of antibiotic treatment for less than 24 hours. Rapid clinical deterioration with concomitant onset of abdominal pain resulted in the diagnosis of cholecystitis, which required cholecystectomy. We performed a systematic literature review using the Pubmed database for the key words “spondylodiscitis”, “spine”, “abdominal” and “cholecystitis”, to identify abdominal diseases that mimic spine pathologies and spinal diseases that mimic abdominal pathologies. Results: No other report in English literature of cholecystitis associated with initial onset of lower back pain was identified. Eighteen reports referred to abdominal conditions that mimic spinal diseases among them a patient with cyclic lumbar back pain who received a lumbar spinal fusion who, after persisting symptoms led to further diagnostic procedures, was ultimately diagnosed with endometriosis. Spinal symptoms included paraplegia and urinary incontinence as results of acute aortic pathologies. Eleven reports presented spinal pain mimicking abdominal conditions including abdominal pain and diarrhea as well as have had surgical procedures such as an appendectomy before the spinal condition was discovered. Conclusion: Clinical symptoms of the spine such as lower back pain can be unspecific and lead to false conclusions in the presence of concomitant pathologies in MRI. Only clinical deterioration in our case patient prompted correction of the diagnosis on day seven. Initial workup for alternative common infectious foci such as lung and urinary tract was performed, but further abdominal workup despite the absence of abdominal symptoms may have led to an earlier diagnosis. Our literature review found several cases of misdiagnosed spinal and abdominal conditions, respectively. Some had undergone unnecessary invasive surgical procedures before the right diagnosis was concluded. Because of the high incidence of symptoms such as lumbar back pain as well as abdominal pain, considering optimal patient care as well as economic aspects it would be essential to conduct an interdisciplinary clinical management to avoid errors in the early stage of diagnostics.

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Section: Literature Review and Discussionmentioning

confidence: 99%

Lumbar Spondylodiscitis Mimicking Cholecystitis: A Case Report and Review of Literature

Mirbagheri

Etminan

Schölch

et al. 2022

J Neurol Surg A Cent Eur Neurosurg

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“…This result is very close to the result previously observed with post-exercise ABI, and supports the use of tcpO2 in the present study. Claudication resulting from isolated proximal-without-distal RBFI is rarely reported in the general population, found as only isolated observations or very small series (22,23). Previous reports have demonstrated that isolated proximal ischemia can mimic symptoms of neurological or musculoskeletal origin (22,24) and may result in isolated distal symptoms in approximately 15% of the cases (25).…”

Section: Overall Prevalence Of Positive Tests and Isolated Proximal Rfbimentioning

confidence: 99%

Proximal Ischemia is a Frequent Cause of Exercise-Induced Pain in Patients with a Normal Ankle to Brachial Index at Rest

Gernigon

Marchand²,

Ouédraogo³

et al. 2013

Pain Phys

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Background: Excluding a vascular origin of exercise-related pain is often difficult in clinical practice. Recent papers have underlined the frequent association of concurrent lumbar spine degenerative disease and peripheral arterial disease. Furthermore, even when suspected, isolated exercise-induced proximal ischemia is difficult to diagnose. Measurement of transcutaneous oxygen pressure (tcpO2) is an interesting and accurate method to differentiate proximal (buttock) from distal (calf) regional blood flow impairment (RBFI) during exercise. Objectives: We searched for isolated proximal-without-distal RBFI as a possible cause of claudication, in patients with borderline (ABI-b: 0.91 - 0.99) or normal (ABI-n: 1.00 to 1.40) ankle to brachial index at rest. Study design: Retrospective cohort design study. We analyzed patients referred to our laboratory with symptom limiting claudication and an ankle brachial index within normal limits. Settings: University-based exercise-investigation center. Methods: Over a 12-year period, we identified 463 patients referred to our laboratory that had their lowest resting ABI between 0.90 and 1.40. The tcpO2 on chest, buttocks, and calves were recorded during treadmill walking tests (3.2 km/h, 10% slope) in 220 ABI-b and 243 ABI-n unique consecutive patients complaining of limiting claudication (each patient’s ABI was the lowest of the 2 legs). Limiting claudication was defined as the reported inability to walk 1 kilometer without stopping. A DROP index (limb tcpO2-changes minus chest tcpO2-changes from rest) below -15 mmHg was used to indicate a positive result (i.e. exercise-induced RBFI). Results: Treadmill exercise showed evidence for proximal or distal RBFI, of at least one side, in 128 out of 220 patients (58.2%) and in 86 out of 243 (35.4%) patients with ABI-b and ABI-n, respectively. Isolated proximal-without-distal RBFI was found in 32 out of the 128 (25.0 %) positive tests in ABI-b and 32 out of the 86 (37.2%) positive tests in ABI-n patients. Limitations: Study limitations include the absence of systematic follow-up of diagnosed patients and absence of systematic search for cardio-respiratory co-morbid conditions. Conclusion: Isolated proximal-without distal RBFI is found in approximately one out of 7 patients complaining of symptom limiting claudication with a borderline or normal resting ABI. Exercise-tcpO2 may help to discriminate patients with arterial claudication that could benefit from invasive vascular investigations and procedures. Key Words: Claudication, diagnosis, prevalence, peripheral arterial disease, transcutaneous oxygen pressure, pathophysiology, exercise testing, arterial pressure, vascular disease

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