1. CASE PRESENTATION
A 69‐year‐old male presented to an emergency department (ED) with acute, chronic, and atraumatic back pain. After interviewing, it was discovered that he was unable to void and had no stools throughout the day. He was vitally stable and noted to have no sensation to pinprick testing below his knees and no rectal tone with notable weakness in his legs. A working diagnosis of cauda equina was made, prompting transfer to a tertiary center. Upon transfer, the initial ED examination was similar with the addition of cool lower extremities and no pedal pulses. Point‐of‐care ultrasound was attempted, though indeterminate. He was diverted from magnetic resonance imaging and taken for immediate computer tomography angiography‐ abdomen and pelvis, which noted an abdominal aortic aneurysm (AAA) that contained rupture measuring 19.8 cm at its widest with possible associated dissection and occlusion (see Figures 1 and 2). Vascular surgery performed an emergent axillobifemoral bypass, and ultimately, the patient had a successful procedure and postoperative course.
FIGURE 1.
Computed tomography: cross‐section of abdomen.
FIGURE 2.
Computed tomography: coronal of abdomen.
2. DIAGNOSIS: ABDOMINAL AORTIC ANEURYSM
This case report highlights a unique clinical presentation of an AAA. Abdominal aortic aneurysms are usually found incidentally or never found at all prior to rupturing causing sudden death. The most common sign is hypertension, and the most common symptom is lower back pain. 1 The classic triad of AAA rupture is hypotension, back or abdominal pain, and a painful pulsatile mass. 1 Dilatation of the aorta ≥3 cm classifies a AAA, and surgical repair is suggested if the diameter is ≥5.5 cm. 2 Aneurysm size and expansion rate are strong predictors for the risk of rupture. 3
Dayal S, Pavlatos N, Griffin P. When cauda equina betrays. JACEP Open. 2024;5:e13148. 10.1002/emp2.13148
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