Case 171: Pain into the back
A man fell and presented with back pain. The casualty doctor was worried about the appearance of the aorta.
1. Which vertebral body is affected?
L2 - The second lumbar vertebral body.2. If the aorta is 'damaged', what possible problems could arise?
Rupture - retroperitoneal or free intraperitoneal ruptureDissection
Embolism to the distal vessels - a cholesterol embolii from this calcified aortic wall could acutely occlude a lower limb vessel.
Occlusion - due to acute thrombosis
All of these eventualities would be unusual, even with this impressive X-ray appearance.
3. Which investigation is required?
Firstly a careful lower limb neurological and vascular examination. Remember this patient has a fractured spine and could possibly have cauda equina (or even conus medullaris / spinal cord) injury. A careful vascular history and examination should exclude significant major vessel compromise.A CT scan will demonstrate the bony abnormality and also any retroperitoneal haematoma.