71-Year-Old Woman With Low Back Pain

Abstract

A 71-year-old woman presented to the outpatient clinic with a chief complaint of having low back pain for 6 months. The back pain was insidious at onset, nonradiating, moderate in intensity, worse at night, and partially relieved with acetaminophen or aspirin. The patient described the pain as a constant, dull, aching sensation and recalled no trauma. She experienced anorexia and reported a 6.8-kg weight loss and decreased energy over the past several months. She also described occasional night sweats. The patient's history was remarkable for bilateral stage I breast cancer, for which she had a bilateral modified radical mastectomy 7 years previously. She also underwent left carotid artery to left subclavian artery bypass surgery for symptomatic left subclavian artery stenosis 4 years previously. Total hysterectomy was performed many years previously for reasons unrelated to cancer. The patient had hyperlipidemia but was not taking a lipid-lowering agent. Several years previously, microscopic hematuria was detected, and findings on cystoscopy and excretory urography were normal. She denied having gross hematuria. The patient was a current smoker with a 30-pack-year history of cigarette smoking. Her current medications were acetaminophen and aspirin on an as-needed basis. Physical examination disclosed a pulse rate of 88/min with a regular rhythm and a blood pressure level of 140/88 mm Hg. Examination of the patient's spine showed no deformity, tenderness, or restriction of joint movements. Findings on the neurologic examination, including gait assessment, motor strength, and reflexes, were unremarkable. Examination of her abdomen revealed a midline, pulsatile mass (5 × 10 cm) extending from the epigastric area to the umbilical area. The mass was nontender and fixed. No bruit was audible over the abdominal mass. The patient had been aware of this mass for several months but had not sought medical attention. She denied recent change in the size of the abdominal mass, abdominal pain, change in bowel habits,

Extravertebral low back pain: a scoping review

“…Mainly middle-aged to older male individuals were affected. Initially 8-18 % of non-inflammatory AAA are symptomatic, while patients with inflammatory AAA exhibit symptoms in 65 to 90% of cases [ 97 ]. The majority of symptomatic patients report chronic LBP, occasionally characterised by a progressive exacerbation.…”

“…The co-occurrence of LBP and abdominal pain was 29.4% [ 100 ]. Furthermore, abdominal pain and a pulsatile abdominal mass in patients with LBP were indicative of the presence of an abdominal aortic aneurysm [ 97 , 99 – 123 ]. The presence of the complete triad of LBP or abdominal pain with hypotension and a pulsatile abdominal mass is rather low at 21% [ 100 ] and usually observed during rupture [ 117 , 118 , 124 ].…”

“…The presence of the complete triad of LBP or abdominal pain with hypotension and a pulsatile abdominal mass is rather low at 21% [ 100 ] and usually observed during rupture [ 117 , 118 , 124 ]. In some cases, history of smoking was reported [ 97 , 102 – 104 , 106 , 108 , 110 , 111 , 115 , 117 , 119 , 121 – 123 , 125 – 132 ]. Other common risk factors are atherosclerotic disease, hypertension, positive family history for AAA and other aneurysms, collagen vascular disease and Marfan and Ehlers-Danlos-syndromes [ 106 , 117 , 119 , 121 – 123 , 133 ].…”

“…The incidence of LBP varies between 58% [ 364 ] and 80% [ 365 ]. Predominantly, it presents as chronic LBP, often accompanied by typical symptoms such as anorexia, fatigue, night sweats, nausea and vomiting [ 97 , 111 , 121 , 365 , 366 ] or lower abdominal pain [ 111 , 121 , 365 , 366 ]. While the two case reports centred around female individuals, findings from the case control and case cohort studies indicated a higher prevalence among males.…”

Abdominal Aortic Aneurysm in a Patient with Claudication Pain

“…Difficult to discern between a patient that has an abdominal aortic aneurysm and a patient that has another cause for the same complaint. Compared with non-inflammatory abdominal aortic aneurysms, 65% to 90% of patients with inflammatory abdominal aortic aneurysms are symptomatic [2]. Some of these patients do present as patients having typical musculoskeletal problems and/or abdominal pain [3].…”