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Kunow A, Freyer Martins Pereira J, Chenot JF. Extravertebral low back pain: a scoping review. BMC Musculoskelet Disord 2024; 25:363. [PMID: 38714994 PMCID: PMC11075250 DOI: 10.1186/s12891-024-07435-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2023] [Accepted: 04/11/2024] [Indexed: 05/12/2024] Open
Abstract
BACKGROUND Low back pain (LBP) is one of the most common reasons for consultation in general practice. Currently, LBP is categorised into specific and non-specific causes. However, extravertebral causes, such as abdominal aortic aneurysm or pancreatitis, are not being considered. METHODS A systematic literature search was performed across MEDLINE, Embase, and the Cochrane library, complemented by a handsearch. Studies conducted between 1 January 2001 and 31 December 2020, where LBP was the main symptom, were included. RESULTS The literature search identified 6040 studies, from which duplicates were removed, leaving 4105 studies for title and abstract screening. Subsequently, 265 publications were selected for inclusion, with an additional 197 publications identified through the handsearch. The majority of the studies were case reports and case series, predominantly originating from specialised care settings. A clear distinction between vertebral or rare causes of LBP was not always possible. A range of diseases were identified as potential extravertebral causes of LBP, encompassing gynaecological, urological, vascular, systemic, and gastrointestinal diseases. Notably, guidelines exhibited inconsistencies in addressing extravertebral causes. DISCUSSION Prior to this review, there has been no systematic investigation into extravertebral causes of LBP. Although these causes are rare, the absence of robust and reliable epidemiological data hinders a comprehensive understanding, as well as the lack of standardised protocols, which contributes to a lack of accurate description of indicative symptoms. While there are certain disease-specific characteristics, such as non-mechanical or cyclical LBP, and atypical accompanying symptoms like fever, abdominal pain, or leg swelling, that may suggest extravertebral causes, it is important to recognise that these features are not universally present in every patient. CONCLUSION The differential diagnosis of extravertebral LBP is extensive with relatively low prevalence rates dependent on the clinical setting. Clinicians should maintain a high index of suspicion for extravertebral aetiologies, especially in patients presenting with atypical accompanying symptoms.
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Affiliation(s)
- Anna Kunow
- Department of General Practice, University Medicine Greifswald, 17475, Fleischmannstraße, Greifswald, Germany.
| | | | - Jean-François Chenot
- Department of General Practice, University Medicine Greifswald, 17475, Fleischmannstraße, Greifswald, Germany
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2
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Alasasfeh I, Abudawood R, E Hwidi B, Al-Shami R. Ruptured abdominal aortic aneurysm discovered by pocket-sized ultrasound in a low resource setting: a case report. Int J Emerg Med 2024; 17:9. [PMID: 38233769 DOI: 10.1186/s12245-023-00579-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 12/19/2023] [Indexed: 01/19/2024] Open
Abstract
BACKGROUND Abdominal aortic aneurysm (AAA) is a life-threatening condition characterized by the weakening and dilation of the abdominal aorta. AAA primarily affects men, smokers, and the elderly, with rupture being a fatal complication. While point-of-care ultrasound (POCUS) is valuable in diagnosing AAA, the role of using pocket-sized ultrasound in a low resource setting remains less explored. This case report presents a unique instance of a suspected ruptured AAA diagnosed using pocket-sized ultrasound in an emergency department (ED) situated in a low resource setting where ultrasound machines are absent, and emergency physicians lack proficiency in ultrasound usage. CASE PRESENTATION A 78-year-old man with a history of hypertension and bladder cancer presented to the ED with suprapubic pain. Initial evaluation showed no concerning findings. However, the next day, he collapsed, became unconscious, and experienced a cardiac arrest. Despite resuscitation efforts, the patient's condition deteriorated. POCUS revealed an 8-cm dilated abdominal aorta with an intimal flap, indicative of a dissecting AAA and a substrate for AAA rupture. Unfortunately, the patient died despite resuscitation efforts. CONCLUSION This case highlights the importance of considering AAA in patients with risk factors and abdominal pain in a low resource setting. POCUS using a pocket-sized ultrasound can aid in early AAA detection, potentially preventing rupture through preemptive vascular intervention. Emergency departments should prioritize ultrasound availability, and emergency physicians should be proficient in its use.
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Affiliation(s)
- Ihab Alasasfeh
- Department of General Surgery, Emergency Medicine Unit/Jordan University Hospital, School of Medicine, The University of Jordan, Amman, Jordan.
| | - Rawan Abudawood
- Department of General Surgery, Emergency Medicine Unit/Jordan University Hospital, School of Medicine, The University of Jordan, Amman, Jordan
| | - Bayan E Hwidi
- School of Medicine, The University of Jordan, Amman, Jordan
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Muacevic A, Adler JR, Wei G, Mccoy JV, Geria R, Rometti M. Does Patient Weight, Age, or Gender Correlate With the Ability to Visualize the Distal Aorta on Bedside Aortic Ultrasounds in the Emergency Department? Cureus 2023; 15:e33822. [PMID: 36819438 PMCID: PMC9930368 DOI: 10.7759/cureus.33822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/14/2023] [Indexed: 01/18/2023] Open
Abstract
INTRODUCTION Abdominal aortic aneurysms (AAA) have a varied presentation, which often makes the diagnosis difficult. The most common location for an AAA is in the infra-renal or distal aorta, which can be difficult to visualize using bedside ultrasound. Objective: This study was designed to identify if a patient's weight, gender, or age influenced our ability to visualize the distal aorta on bedside abdominal aortic ultrasound scans. Methods: All aortic scans completed in the Emergency Department (ED) from September 2010 to September 2013 were retrospectively evaluated. Patients 21 years and older were included. Scans missing age, gender, or self-reported weight were excluded. Results: 500 aortic scans were included. The distal aorta was visualized in 393 scans (78.6%). The mid aorta was visualized in 417 scans (83.4%). The proximal aorta was visualized in 454 scans (90.8%). For the distal aorta, the average weight for visualized versus not visualized was 75.7 kg versus 79.7 kg. For the proximal aorta, the average weight for visualized versus not visualized was 75.8 kg versus 84.0 kg. Weight significantly predicted the ability to visualize the proximal aorta (unadjusted p=0.0098, adjusted p=0.0095) and marginally predicted the ability to visualize the distal aorta (unadjusted p=0.071, adjusted p=0.019). Neither age (unadjusted p=0.13, adjusted p=0.052) nor gender (unadjusted p=0.74, adjusted p=0.40) was significantly associated with visualization. CONCLUSION There is no clinically significant difference in the ability to visualize a patient's distal aorta with bedside ultrasound based on a patient's body weight, gender, or age.
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Thalmann NF, Rimensberger C, Blum MR, Liechti FD, Wertli MM. [Internal differential diagnoses in acute back pain : An internal perspective on the possible causes of acute back pain]. Z Rheumatol 2023; 82:3-9. [PMID: 36094629 PMCID: PMC9894948 DOI: 10.1007/s00393-022-01257-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/06/2022] [Indexed: 02/06/2023]
Abstract
The majority of patients with acute back pain have no serious underlying disease; however, many internal diseases can be manifested as acute or chronic back pain. Therefore, in the assessment of patients with back pain the clinical history and clinical examination are important in order to detect indications for a possible underlying disease. Particularly red flags that indicate an acute or life-threatening disease should not be missed. In most cases where such red flags, risk factors or clinical indications are not present, no systematic search for internal underlying diseases is necessary. This article summarizes the most relevant differential diagnoses and clinical indications as well as warning symptoms.
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Affiliation(s)
- Nicolas F Thalmann
- Allgemeine Innere Medizin, Universitätsspital Bern, Inselspital, Freiburgstr. 18, 3010, Bern, Schweiz.
| | - Caroline Rimensberger
- Allgemeine Innere Medizin, Universitätsspital Bern, Inselspital, Freiburgstr. 18, 3010, Bern, Schweiz
| | - Manuel R Blum
- Allgemeine Innere Medizin, Universitätsspital Bern, Inselspital, Freiburgstr. 18, 3010, Bern, Schweiz
- Berner Institut für Hausarztmedizin (BIHAM), Universität Bern, Mittelstr. 43, 3012, Bern, Schweiz
| | - Fabian D Liechti
- Allgemeine Innere Medizin, Universitätsspital Bern, Inselspital, Freiburgstr. 18, 3010, Bern, Schweiz
| | - Maria M Wertli
- Allgemeine Innere Medizin, Universitätsspital Bern, Inselspital, Freiburgstr. 18, 3010, Bern, Schweiz
- Departement Innere Medizin, Kantonsspital Baden, Im Ergel 1, 5404, Baden, Schweiz
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Machado M, Neto D, Paiva D, Fernandes C, Cotter J. A Case Report: A 75-Year-Old Male With Abdominal Pain, Diarrhea, and Hypotension. Cureus 2022; 14:e29166. [PMID: 36258956 PMCID: PMC9567234 DOI: 10.7759/cureus.29166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/13/2022] [Indexed: 11/18/2022] Open
Abstract
The differential diagnosis of abdominal pain ranges from benign to life-threatening conditions. This case report describes the importance of the differential diagnosis and a faster and more accurate diagnosis. A 75-year-old male presented to the emergency room (ER) with diffuse abdominal pain, associated nausea, vomiting, diarrhea, and a fever of 38.5ºC since the previous day. Medical history included hypertension, dyslipidemia, and obesity. Clinical examination showed hypotension and a distended abdomen with diffuse tenderness in all quadrants. Blood tests revealed a hemoglobin of 11.3 g/dL, and an arterial blood gas test revealed metabolic acidosis and lactate of 8 mmol/L. Contrast-enhanced computed tomography (CT) of the abdomen and pelvis revealed a large aneurysm in the infrarenal aorta with an extension of about 17x8x8 cm and an exuberant mural thrombus. The patient underwent endovascular treatment of the aneurysm; however, he died during surgery.
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Hattab O, Amaqdouf S, El Ouafi N, Bazid Z. Painless long-segmental aortic dissection diagnosed by echocardiography: a case report of a diagnostic conundrum with potentially poor outcome. Radiol Case Rep 2022; 17:3294-3297. [PMID: 35846503 PMCID: PMC9284380 DOI: 10.1016/j.radcr.2022.06.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 06/07/2022] [Accepted: 06/08/2022] [Indexed: 10/27/2022] Open
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Wang PH, Chen JY, Ling DA, Lee AF, Ko YC, Lien WC, Huang CH. Earlier point-of-care ultrasound, shorter length of stay in patients with acute flank pain. Scand J Trauma Resusc Emerg Med 2022; 30:29. [PMID: 35449010 PMCID: PMC9021562 DOI: 10.1186/s13049-022-01017-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 04/10/2022] [Indexed: 12/23/2022] Open
Abstract
Background The effects of early integration of point-of-care ultrasound (PoCUS) into patient care are uncertain. This study aims to investigate the effects of early PoCUS on patients with acute flank pain. Methods Adult non-traumatic patients with acute flank pain receiving PoCUS were enrolled. Expert physicians reviewed the medical records and made the “final diagnosis” for the cause of acute flank pain. The primary outcome was the relationship between the door to ultrasound (US) time and length of stay (LOS). The secondary outcomes included the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of the sonographic diagnosis, compared with the final diagnosis. Results Eight hundred and eighty-eight patients were included in the analysis. Patients receiving early PoCUS (≤120 min) had a shorter LOS (128 vs. 217 min, p < 0.0001). Patients in the late POCUS group (> 120 min) had a trend to receive more CT scans. The disease distribution, sensitivity, specificity, PPV, and NPV were similar in patients receiving early or late PoCUS for target diagnoses. After adjusting for the confounders, early PoCUS (OR, 2.77, 95% CIs, 1.93–3.98) had a positive impact on shorter LOS. In addition, the effect of early PoCUS became more prominent (OR, 4.91, 95% CIs, 3.39–7.13) on LOS in less than 3 h. Conclusions Early integration of PoCUS is significantly related to shorter LOS in patients with acute flank pain without increasing morbidity and mortality. Our results suggested “PoCUS early” in these patients to possibly alleviate emergency department crowding. Trial registration NCT04149041 at the ClinicalTrial.gov.
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Affiliation(s)
- Pei-Hsiu Wang
- Department of Emergency Medicine, National Taiwan University Hospital, No. 7, Chung-Shan S. Road, Taipei, 100, Taiwan
| | - Jia-Yu Chen
- Department of Emergency Medicine, National Taiwan University Hospital, No. 7, Chung-Shan S. Road, Taipei, 100, Taiwan
| | - Dean-An Ling
- Department of Emergency Medicine, National Taiwan University Hospital, No. 7, Chung-Shan S. Road, Taipei, 100, Taiwan
| | - An-Fu Lee
- Department of Emergency Medicine, National Taiwan University Hospital, No. 7, Chung-Shan S. Road, Taipei, 100, Taiwan
| | - Ying-Chih Ko
- Department of Emergency Medicine, National Taiwan University Hospital, No. 7, Chung-Shan S. Road, Taipei, 100, Taiwan
| | - Wan-Ching Lien
- Department of Emergency Medicine, National Taiwan University Hospital, No. 7, Chung-Shan S. Road, Taipei, 100, Taiwan. .,Department of Emergency Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan.
| | - Chien-Hua Huang
- Department of Emergency Medicine, National Taiwan University Hospital, No. 7, Chung-Shan S. Road, Taipei, 100, Taiwan.,Department of Emergency Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
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Fernando SM, Tran A, Cheng W, Rochwerg B, Strauss SA, Mutter E, McIsaac DI, Kyeremanteng K, Kubelik D, Jetty P, Nagpal SK, Thiruganasambandamoorthy V, Roberts DJ, Perry JJ. Accuracy of presenting symptoms, physical examination, and imaging for diagnosis of ruptured abdominal aortic aneurysm: Systematic review and meta-analysis. Acad Emerg Med 2022; 29:486-496. [PMID: 35220634 DOI: 10.1111/acem.14475] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Revised: 12/21/2021] [Accepted: 01/04/2022] [Indexed: 12/29/2022]
Abstract
OBJECTIVES Ruptured abdominal aortic aneurysm (rAAA) is a life-threatening condition, and rapid diagnosis is necessary to facilitate early surgical intervention. We sought to evaluate the accuracy of presenting symptoms, physical examination signs, computed tomography with angiography (CTA), and point-of-care ultrasound (PoCUS) for diagnosis of rAAA. METHODS We searched six databases from inception through April 2021. We included studies investigating the accuracy of any of the above tests for diagnosis of rAAA. The primary reference standard used in all studies was intraoperative diagnosis or death from rAAA. Because PoCUS cannot detect rupture, we secondarily assessed its accuracy for the diagnosis of AAA, using the reference standard of intraoperative or CTA diagnosis. We used GRADE to assess certainty in estimates. RESULTS We included 20 studies (2,077 patients), with 11 of these evaluating signs and symptoms, seven evaluating CTA, and five evaluating PoCUS. Pooled sensitivities of abdominal pain, back pain, and syncope for rAAA were 61.7%, 53.6%, and 27.8%, respectively (low certainty). Pooled sensitivity of hypotension and pulsatile abdominal mass were 30.9% and 47.1%, respectively (low certainty). CTA had a sensitivity of 91.4% and specificity of 93.6% for diagnosis of rAAA (moderate certainty). In our secondary analysis, PoCUS had a sensitivity of 97.8% and specificity of 97.0% for diagnosing AAA in patients suspected of having rAAA (moderate certainty). CONCLUSIONS Classic clinical symptoms associated with rAAA have poor sensitivity, and their absence does not rule out the condition. CTA has reasonable accuracy, but misses some cases of rAAA. PoCUS is a valuable tool that can help guide the need for urgent transfer to a vascular center in patients suspected of having rAAA.
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Affiliation(s)
- Shannon M. Fernando
- Department of Emergency Medicine University of Ottawa Ottawa Ontario Canada
- Division of Critical Care, Department of Medicine University of Ottawa Ottawa Ontario Canada
| | - Alexandre Tran
- Division of Critical Care, Department of Medicine University of Ottawa Ottawa Ontario Canada
- Division of General Surgery, Department of Surgery University of Ottawa Ottawa Ontario Canada
- School of Epidemiology and Public Health University of Ottawa Ottawa Ontario Canada
| | - Wei Cheng
- Department of Biostatistics, Yale School of Public Health Yale University New Haven Connecticut USA
| | - Bram Rochwerg
- Department of Medicine, Division of Critical Care McMaster University Hamilton Ontario Canada
- Department of Health Research Methods, Evidence, and Impact McMaster University Hamilton Ontario Canada
| | - Shira A. Strauss
- School of Epidemiology and Public Health University of Ottawa Ottawa Ontario Canada
- Division of Vascular Surgery, Department of Surgery University of Ottawa Ottawa Ontario Canada
| | - Eric Mutter
- Department of Emergency Medicine University of Ottawa Ottawa Ontario Canada
| | - Daniel I. McIsaac
- School of Epidemiology and Public Health University of Ottawa Ottawa Ontario Canada
- Clinical Epidemiology Program; Ottawa Hospital Research Institute Ottawa Ontario Canada
- Department of Anesthesiology and Pain Medicine University of Ottawa Ottawa Ontario Canada
| | - Kwadwo Kyeremanteng
- Division of Critical Care, Department of Medicine University of Ottawa Ottawa Ontario Canada
- Clinical Epidemiology Program; Ottawa Hospital Research Institute Ottawa Ontario Canada
| | - Dalibor Kubelik
- Division of Critical Care, Department of Medicine University of Ottawa Ottawa Ontario Canada
- Division of Vascular Surgery, Department of Surgery University of Ottawa Ottawa Ontario Canada
| | - Prasad Jetty
- Division of Vascular Surgery, Department of Surgery University of Ottawa Ottawa Ontario Canada
- Clinical Epidemiology Program; Ottawa Hospital Research Institute Ottawa Ontario Canada
| | - Sudhir K. Nagpal
- Division of Vascular Surgery, Department of Surgery University of Ottawa Ottawa Ontario Canada
- Clinical Epidemiology Program; Ottawa Hospital Research Institute Ottawa Ontario Canada
| | - Venkatesh Thiruganasambandamoorthy
- Department of Emergency Medicine University of Ottawa Ottawa Ontario Canada
- School of Epidemiology and Public Health University of Ottawa Ottawa Ontario Canada
- Clinical Epidemiology Program; Ottawa Hospital Research Institute Ottawa Ontario Canada
| | - Derek J. Roberts
- Division of Vascular Surgery, Department of Surgery University of Ottawa Ottawa Ontario Canada
- Clinical Epidemiology Program; Ottawa Hospital Research Institute Ottawa Ontario Canada
| | - Jeffrey J. Perry
- Department of Emergency Medicine University of Ottawa Ottawa Ontario Canada
- School of Epidemiology and Public Health University of Ottawa Ottawa Ontario Canada
- Clinical Epidemiology Program; Ottawa Hospital Research Institute Ottawa Ontario Canada
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Patel J, Olson C, Beaver B, Jackson BS. Middle-Aged Man With Back Pain and Hypotension. Ann Emerg Med 2022; 79:e23-e24. [PMID: 35337484 DOI: 10.1016/j.annemergmed.2021.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Janak Patel
- Department of Emergency Medicine, University of Kansas Medical Center, Kansas City, KS.
| | - Caitlin Olson
- Department of Emergency Medicine, University of Kansas Medical Center, Kansas City, KS
| | - Bryan Beaver
- Department of Emergency Medicine, University of Kansas Medical Center, Kansas City, KS
| | - Bradley S Jackson
- Department of Emergency Medicine, University of Kansas Medical Center, Kansas City, KS
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10
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Kessler V, Klopf J, Eilenberg W, Neumayer C, Brostjan C. AAA Revisited: A Comprehensive Review of Risk Factors, Management, and Hallmarks of Pathogenesis. Biomedicines 2022; 10:94. [PMID: 35052774 PMCID: PMC8773452 DOI: 10.3390/biomedicines10010094] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 12/30/2021] [Indexed: 01/27/2023] Open
Abstract
Despite declining incidence and mortality rates in many countries, the abdominal aortic aneurysm (AAA) continues to represent a life-threatening cardiovascular condition with an overall prevalence of about 2-3% in the industrialized world. While the risk of AAA development is considerably higher for men of advanced age with a history of smoking, screening programs serve to detect the often asymptomatic condition and prevent aortic rupture with an associated death rate of up to 80%. This review summarizes the current knowledge on identified risk factors, the multifactorial process of pathogenesis, as well as the latest advances in medical treatment and surgical repair to provide a perspective for AAA management.
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Affiliation(s)
| | | | | | | | - Christine Brostjan
- Department of General Surgery, Division of Vascular Surgery, Medical University of Vienna, Vienna General Hospital, 1090 Vienna, Austria; (V.K.); (J.K.); (W.E.); (C.N.)
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Vélez-Leal JL, Pérez-Arroyave NA, Sánchez-Castro C, Uribe-Londoño LM, Moncayo-Viveros JG. Disección espontánea del tronco celíaco. Una emergencia vascular inusual. REVISTA COLOMBIANA DE CIRUGÍA 2021. [DOI: 10.30944/20117582.908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Introducción. La disección espontánea del tronco o arteria celíaca es una emergencia vascular abdominal inusual, con una incidencia desconocida. Actualmente no existen guías o consensos para su tratamiento, el cual va desde intervenciones vasculares mayores hasta la conducta expectante.
Caso clínico. Paciente masculino de 42 años sin antecedentes patológicos, con dolor abdominal intenso de un mes de evolución. Ante la sospecha clínica de patología inflamatoria se realizó una tomografía computarizada abdominal con medio de contraste, en la que se observó una disección del tronco celíaco asociada a un infarto esplénico. Se realizó manejo endovascular de forma exitosa.
Discusión. La disección espontánea del tronco celíaco es una patología infrecuente, que puede presentarse en pacientes con hipertensión arterial, tabaquismo, enfermedad ateroesclerótica y vasculitis. Los síntomas más comunes son el dolor abdominal asociado a náuseas y vómito. La sospecha clínica debe ser confirmada mediante estudios imagenológicos que orienten al tratamiento conservador, endovascular o quirúrgico, ante la sospecha de infarto intestinal o ruptura arterial.
Conclusiones. La disección espontánea del tronco celíaco es una patología vascular inusual que puede relacionarse con una alta mortalidad. Es importante tener siempre presente la interrelación entre la anatomía vascular abdominal, la anamnesis y el examen físico como elementos claves para realizar este diagnóstico.
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Patel TV, Canario DAH, Isaacson AJ, Mauro DM. Vascular Etiologies of the Acute Abdomen. Semin Roentgenol 2020; 55:417-426. [PMID: 33220787 DOI: 10.1053/j.ro.2020.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Tirth V Patel
- Department of Radiology, University of North Carolina School of Medicine, Chapel Hill, NC
| | | | - Ari J Isaacson
- Department of Radiology, University of North Carolina School of Medicine, Chapel Hill, NC
| | - David M Mauro
- Department of Radiology, University of North Carolina School of Medicine, Chapel Hill, NC.
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Diaz O, Eilbert W. Ruptured abdominal aortic aneurysm identified on point-of-care ultrasound in the emergency department. Int J Emerg Med 2020; 13:25. [PMID: 32410576 PMCID: PMC7227275 DOI: 10.1186/s12245-020-00279-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Accepted: 04/14/2020] [Indexed: 11/10/2022] Open
Abstract
Background Ruptured abdominal aortic aneurysm (AAA) is a highly lethal condition which requires rapid identification and treatment to improve the chance of survival. Computed tomography is the diagnostic modality of choice for ruptured AAA though it is time-consuming and often requires movement of the patient out of the emergency department (ED). Point-of-care ultrasound in the ED has excellent sensitivity and specificity for the detection of AAA, though less is known about its use to diagnose AAA rupture. We report a case of ruptured AAA identified on ultrasound performed at the bedside in the ED. Case presentation A 77-year-old woman on warfarin with a known AAA presented to our ED with 2 days of epigastric abdominal pain. Point-of-care ultrasound revealed several findings suggestive of rupture of the AAA, which was confirmed on computed tomography. The patient was subsequently taken for emergent operative repair of the AAA and was later discharged from the hospital. Conclusions Characteristics suggestive of AAA rupture may be seen on ultrasound. As ED physicians become more familiar with the use of point-of-care ultrasound in the evaluation of abdominal pain, identification of these characteristics may aid in the rapid diagnosis of AAA rupture.
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Affiliation(s)
- Omar Diaz
- Department of Emergency Medicine, University of Illinois at Chicago, College of Medicine, Room 469, COME 1819 West Polk St, Chicago, IL, 60612, USA
| | - Wesley Eilbert
- Department of Emergency Medicine, University of Illinois at Chicago, College of Medicine, Room 469, COME 1819 West Polk St, Chicago, IL, 60612, USA.
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Goldstein LN, Wells M. Point-of-care Ultrasound Trumps Computed Tomography in a Case of Abdominal Aortic Aneurysm Assessment. Cureus 2019; 11:e5989. [PMID: 31807377 PMCID: PMC6876902 DOI: 10.7759/cureus.5989] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Patients who present to the emergency department (ED) with aortic emergencies can be some of the highest acuity patients that we manage. Ultrasonography performed at the bedside is traditionally considered to be a screening test that is especially useful in the unstable patient. Computed tomography (CT) with angiography is the imaging modality of choice to confirm the diagnosis and plan the management of abdominal aortic aneurysm (AAA), as an ultrasound is generally thought not to provide the clinician with sufficient anatomical information. We present a case of a patient with an abdominal aortic aneurysm where evidence obtained from the ultrasound provided more useful information regarding aneurysm structure and stability than did CT.
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Affiliation(s)
- Lara N Goldstein
- Emergency Medicine, University of the Witwatersrand, Johannesburg, ZAF
| | - Mike Wells
- Emergency Medicine, University of the Witwatersrand, Johannesburg, ZAF
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