A 64-year-old male with a history of hypertension presents to the emergency with severe back pain. He states that he was straining to pick up a box in the hospital storeroom in which he works when it started. His vitals at the emergency room shortly thereafter are T 98.7, HR 110, BP 90/65, and RR 20. Which of the following is the most likely diagnosis?
1.Verterbral compression fracture
2.Muscle strain
3.Herniated disk
4.Ruptured aortic aneurysm
5.Spondylolisthesis
exp:
Even though the patient was lifting when the pain started, the presentation of acute onset back pain and severe hypotension is a ruptured aortic aneurysm until proven otherwise.
Abdominal aortic aneurysms (AAA) are generally asymptomatic and can be discovered incidentally on exam or imaging study. As it enlarges, an AAA may cause a pulsatile sensation, back pain, and vague epigastric pain. Upon rupture, AAAs cause severe, tearing abdominal pain radiating to the back and hypotension. Emergent surgery is required.
Illustration A shows a CT scan of a ruptured abdominal aortic aneurysm.