title: Acute aortic dissection or ruptured aortic aneurysm associated with back pain and paraplegia.
abstract: Acute aortic dissection and a ruptured aortic aneurysm are both catastrophic events that usually present suddenly. Although these conditions are relatively uncommon compared to other diseases treated by the orthopedists as a primary practitioner, they are of primary importance. The purpose of this study was to investigate the key points that differentiate these conditions from spinal disease. A review of 50 patients with aortic dissection (n=40) or a ruptured aortic aneurysm (n=10) was performed to determine the manifestations (eg, back pain and paraplegia). We also evaluated the predisposing factor and blood pressure on admission and reviewed clinical imaging (radiographs, computed tomography [CT]) retrospectively. Sudden severe isolated back pain was observed in 18 (45.0%) of 40 patients, and 31 (77.5%) of 40 patients had at least some back pain in aortic dissection, while 1 patient had sudden paraplegia with a ruptured aortic aneurysm. Hypertension was the most predisposing factor and was present in 29 (58.0%) of 50 patients. On admission, hypertension was present in 26 (56.5%) of 46 patients, and hypotension was present in 14 (30.4%) of 46 patients. In all cases, the correct diagnosis was made based on CT. For a patient with an abrupt onset of severe back pain, acute aortic dissection and a ruptured aortic aneurysm should be considered in the differential diagnosis from spinal disease. The most reliable tool for imaging diagnosis was CT.
authors.affiliation: Department of Orthopedic Surgery, School of Medicine, Kanazawa University, 13-1 Takaramachi, Kanazawa 920-8641, Japan.
authors.forename: Katsuhito
authors.initials: K
authors.lastname: Yoshioka
authors.forename: Yasumitsu
authors.initials: Y
authors.lastname: Toribatake
authors.forename: Norio
authors.initials: N
authors.lastname: Kawahara
authors.forename: Katsuro
authors.initials: K
authors.lastname: Tomita
mesh_terms: D000368:Aged; D000784:Aortic Dissection / Q000175:diagnosis / Q000453:epidemiology*; D001019:Aortic Rupture / Q000175:diagnosis / Q000453:epidemiology*; D001416:Back Pain / Q000175:diagnosis / Q000453:epidemiology*; D015897:Comorbidity; D005260:Female; D006801:Humans; D015994:Incidence; D007564:Japan / Q000453:epidemiology; D008297:Male; D010264:Paraplegia / Q000175:diagnosis / Q000453:epidemiology*; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors