Ruptured abdominal aortic aneurysm masquerading as isolated hip pain: an unusual presentation

Abstract

The rupture of an abdominal aortic aneurysm (AAA) is a catastrophic event. Misdiagnosis by first-contact emergency physicians remains a serious concern. Varied and frequently nonspecific presentations lead to erroneous diagnostic impressions and cause significant delays in definitive intervention. We report the case of a 73-year-old man with a ruptured AAA presenting with isolated acute right hip pain without any classical features such as truncal pain or hypotension. Despite major advances in imaging and definitive treatment, a heightened awareness among emergency physicians remains the only effective means of improving detection and thereby survival.

Inflammatory abdominal aortic aneurysm: a persistent painful hip

“…In this case, the initial presentation was of constant chronic left hip pain, which is normally secondary to lower limb or spine musculoskeletal pathology. The presentation of isolated hip pain related to AAA has been reported twice previously and is thought to be referred pain originating from the nerves in the lumbar plexus 8 9. This plexus, which is formed by the ventral rami of the first four lumbar spinal nerves supplies sensory innervation to the skin and musculature overlying the hip joint.…”

Ruptured Abdominal Aortic Aneurysm in an Elderly Man

“…Mortality with a ruptured AAA is 41% to 50% and is directly associated with timeliness of diagnosis and surgical intervention; misleading and atypical presentation caused most delays . Ruptured AAAs have a wide variety of presenting symptoms . The classical presentation of a ruptured AAA includes the triad of hypotension, abdominal or back pain, and a pulsatile abdominal mass, although this triad is present in only 25% to 50% of individuals …”

Unusual emergent presentations of abdominal aortic aneurysm: Can simple blood tests predict the state of emergency

“…[28] The diagnosis can be missed especially when the patients present with atypical clinical symptoms such as hip pain, [29] groin pain, [24] hematuria, tenesmus, and hydronephrosis. [25] These atypical clinical symptoms can lead to diagnostic error, such as urethral colic, lumbar disc herniation, sciatica, acute myocardial infarction, perforated peptic ulcer, acute pancreatitis, acute cholecystitis, mesenteric vascular occlusion, and acute diverticulitis.…”