Acute aortic thrombus presenting as low back pain with neurological deficits

Abstract text (incl. references and figure legends)

Low back pain is most commonly caused by mechanical dysfunction.Although the differential for low back pain is quite broad,serious vascular or visceral disease may be the cause of low back pain in a small per­centage of patients.Occlusive abdominal aortic thrombus is a rare but lifethreatening emergency with devastating consequences.

A 71-year-old male patient presented to the Emergency Department with a 24 hour history of severe back pain radiating right leg.This was associated with leg weakness and paresthesia.He was a diabetic with hypertension and dyslipidemia, a heavy smoker and history of abdominal aortic aneurysm accompanied in other institution.

The patient reported similarsymptoms over the past 2months with sudden acute worsening with prompted attendance at the ED.Clinical examination revealed low back pain and global left lower limb weakness with 1/5 power.Both feet were noted to be cool to the touch with a pale blueish discoloration with absence of peripheral pulses,poor capillary filling and coldness in both legs.

An emergent CT angiogram was performed which demonstrated aortic thrombus extending from the origin of the SMA to the iliac bifurcation.A diagnosis of occlusive abdominal aortic thrombosis of the aneurysm was made.
The patient underwent an emergency axillofemoral bypass with dacron prosthesis in the same day,which was successful,with efficacious restoration of blood flow.

Nontraumatic acute thrombosis of the aorta is a lifethreatening condition that may present with apparently neurological symptoms and is an unusual occurrence, although well documented.
Physicians and associate specialists should consider this at clinical assessment and any delay in diagnosing an aortic thrombosis has the potential for catastrophic clinical consequences.
Successful management depends on efficacious restoration of blood flow and long-term outcome will be adversely implicated with advancing atherosclerotic disease and in patients who continue to smoke.

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