Differential Diagnosis of a Patient Referred to Physical Therapy With Low Back Pain: Abdominal Aortic Aneurysm

Mechelli, Filippo; Preboski, Zachary; Boissonnault, William G.

doi:10.2519/jospt.2008.2719

Cited by 31 publications

(36 citation statements)

References 40 publications

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“…7 Patients may mention hip, flank, groin, or buttock pain in addition to their back or abdominal pain. 6,8 The pain is often vague; but when there is compression of an AAA on an adjacent structure such as a vertebral end plate, the pain may be described as sharp or stabbing. 6 Patients may also report nausea, weight loss, early satiety, or a feeling of fullness.…”

Section: Discussionmentioning

confidence: 99%

“…6 Patients may also report nausea, weight loss, early satiety, or a feeling of fullness. 7,8 Distal embolization or aortic occlusion due to thrombosis may give leg symptoms, with symptoms of sudden ischemia, painful cyanotic toes, and palpable pedal pulses. A rupture or dissection (in which hemorrhage into the media separates the layers of the vessel) causes more acute pain and has a sudden onset.…”

Section: Discussionmentioning

confidence: 99%

“…3 The majority of those diagnosed with AAA are 65 years and older. 8 Abdominal aortic aneurysm is 5 to 10 times more common in men than in women. 2,6,7 This particular patient matches the criteria for risk factors of age, sex, and history of smoking.…”

Section: Discussionmentioning

confidence: 99%

“…4,6,8,9 Patients who have had abdominal imaging performed in the past 5 years are less likely to have AAA larger than 4.0 cm. 9 This patient did not have any other health complaints, which means that he either did not have any of the abovementioned risk factors or that he had not been questioned about it.…”

Section: Discussionmentioning

confidence: 99%

“…10 The usefulness of the clinical examination to detect AAA is limited. However, Mechelli et al 8 state that abdominal palpation and auscultation are important, especially when there is a suspicion of a nonmechanical or abdominal pathology for low back pain or when patients do not respond to the treatment. Another reason for clinical examination is when the clinical history gives a suspicion for AAA.…”

Section: Discussionmentioning

confidence: 99%

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Clinical detection of abdominal aortic aneurysm in a 74-year-old man in chiropractic practice

Boer

Knaap²,

Zoete³

2010

Journal of Chiropractic Medicine

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Objective: The purpose of this article is to present a case of abdominal aortic aneurysm to illustrate its clinical detection through history and physical examination and the importance of this condition to the chiropractic clinical setting. Clinical Features: A 74-year-old retired man consulted a doctor of chiropractic for chronic low back pain. The history and physical examination confirmed chronic sacroiliac and a lumbar facet dysfunction. After 5 weeks, the patient stated he had stomach cramps. After this, a more thorough abdominal examination was done. The doctor of chiropractic detected an enlarged pulsatile mass upon abdominal palpation. Intervention and outcome: The patient was sent to the cardiologist and had successful surgery within weeks. Conclusion: An abdominal aortic aneurysm has specific symptoms and associated risk factors. If known risk factors are present, a clinical examination needs to be carried out, even though sensitivity of the clinical examination may be low. It should be a differential diagnosis in every male patient older than 50 years with low back pain. In case of suspicion, the patient should be referred for advanced imaging.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 3 more Smart Citations

Clinical detection of abdominal aortic aneurysm in a 74-year-old man in chiropractic practice

Boer

Knaap²,

Zoete³

2010

Journal of Chiropractic Medicine

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Abdominal aortic aneurysm presenting to the orthopedic clinic as posterior hip and low back pain

Marcel

Jovan

Myrick

2023

Clinical Case Reports

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An abdominal aortic aneurysm (AAA) is a permanent dilatation of the infrarenal aorta that is 3 cm or greater in diameter or equivalent to 1.5 times the normal anteroposterior diameter. 1,2 Risk factors for AAA include smoking, male sex, age greater than 65 years old, high systolic blood pressure, high body mass index, high serum triglycerides, high lowdensity lipoprotein, family history of AAA, coronary artery disease (CAD), atherosclerosis, stroke, and diabetes mellitus with concomitant CAD and peripheral artery disease (PAD). [3][4][5][6][7][8] Of these, smoking is the greatest contributor to the development of AAA. 3,4,9 In smokers, growth rate increases by an additional 0.35 mm/year and rupture rate doubles. 7 Most unruptured AAAs are asymptomatic and are found incidentally while investigating some other pathology. 4,5,7,10 However, when symptomatic, unruptured AAA may present with unexplained abdominal discomfort and pain that radiates to the back, flank, or groin, as well as a pulsatile abdominal mass with or without a bruit heard at the mass. 4,11 The generalized pain from a symptomatic AAA may be confused with an orthopedic etiology. A patient presenting with what seems to be a musculoskeletal (MSK)

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Anévrisme aortique abdominale : dépistage d’une lombalgie mortelle. Étude d’un cas et données de la littérature pour le dépistage

Osinski¹

2015

Kinésithérapie, la Revue

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Differential Diagnosis of a Patient Referred to Physical Therapy With Low Back Pain: Abdominal Aortic Aneurysm

Cited by 31 publications

References 40 publications

Clinical detection of abdominal aortic aneurysm in a 74-year-old man in chiropractic practice

Clinical detection of abdominal aortic aneurysm in a 74-year-old man in chiropractic practice

Abdominal aortic aneurysm presenting to the orthopedic clinic as posterior hip and low back pain

Anévrisme aortique abdominale : dépistage d’une lombalgie mortelle. Étude d’un cas et données de la littérature pour le dépistage

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