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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 rupture
Dissection
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.