Ruptured abdominal aortic aneurysm presenting as buttock pain

Testicular pain as a warning symptom of a symptomatic abdominal aortic aneurysm: case report and review of the literature

INTRODUCTION

Isolated testicular pain is an unusual clinical presentation of symptomatic abdominal aortic aneurysms (AAA). We present two patients hemodynamically stable with an isolated acute testicular pain related to an AAA and a review of the published literature up to present.

CASE REPORT

Two adult-old males with an acute isolated testicular pain presented to the emergency department. Although both cases had their symptoms for more than 24 hours and were hemodynamically stable, the misdiagnosis of a urological condition in one case and a delay of the intervention in the second resulted in a sudden drop of vital signs and the need of an urgent open surgery.

DISCUSSION

A bibliographic review of the 15 published cases is presented. Most cases occurred without a previous diagnosis of AAA. Aneurysms were characteristically very large (mean 10 cm). The initial diagnosis was frequently wrong, attributing the pain mostly to genito-urinary conditions. The testicular pain presented days and even weeks before rupture, which may offer a convenient window of hemodynamic stability for repair.

CONCLUSIONS

Acute testicular pain in adult-old patients with aneurysm risk factors and specially with a first urological evaluation discarding a genitourinary disorder should alert clinicians to consider the diagnosis of a symptomatic abdominal aortic aneurysm. The early and accurate recognition of these cases may increase the survival.

Contained ruptured abdominal aortic aneurysm presenting as cauda equina syndrome

This is the case report of a contained ruptured aortic aneurysm presenting with acute cauda equina syndrome. The patient was a 79-year-old man. A literature search revealed various unusual presentations of abdominal aortic aneurysm (AAA), including femoral neuropathy, hip pain and others; however, there are no other reports of cauda equina-like syndrome. The present case is therefore another unusual presentation of ruptured abdominal aortic aneurysm and reiterates the utmost importance of careful history taking and clinical examination. Abdominal aortic aneurysm rupture should always be considered in the differential diagnosis of sudden onset isolated lower limb neuropathies and or pain.

Can release of urinary retention trigger abdominal aortic aneurysm rupture?

Only 50% of abdominal aortic aneurysms present with the classic triad of hypotension, back pain and a pulsatile abdominal mass. This variability in symptoms can delay diagnosis and treatment. We present the case of a patient presenting with a unique combination of symptoms suggesting that decompression of urinary retention can lead to abdominal aortic aneurysm rupture.

Ruptured abdominal aortic aneurysm diagnosed through non-contrast MRI

Rupture of an aneurysm is a rare complication although it is considered a common cause of death. Some of these patients present with the classic triad of symptoms such as abdominal pain, pulsatile abdominal mass and shock. Most symptoms are misleading and will only present as vague abdominal pain. Here we describe one such patient with an unusual presentation of a misleading abdominal mass which was eventually diagnosed as a ruptured abdominal aortic aneurysm after an emergency MRI.

Patient screening by a physical therapist for nonmusculoskeletal hip pain

BACKGROUND AND PURPOSE

Mechanical hip pain and disease-based hip pain can have similar signs and symptoms, thereby presenting a differential diagnostic challenge for clinicians. Hip pain is a common complaint addressed by physical therapists; therefore, it would be advantageous for them to be knowledgeable about differential diagnosis for hip pain, so that they can screen for possible serious conditions outside the realm of physical therapist practice and make the appropriate referral.

CASE DESCRIPTION

A 77-year-old man was referred for physical therapy by his primary care physician (PCP) with diagnoses of lumbar spine and left hip osteoarthritis and possible trochanteric bursitis. After the examination, the physical therapist determined that the patient should return to his PCP for further testing. Findings leading to this conclusion were pain severity out of proportion to the reported injury, the presence of night pain, a positive "sign of the buttock," and empty end feels of all hip joint motions, which represented a noncapsular pattern of joint restriction.

OUTCOMES

The patient was diagnosed later with primary lung adenocarcinoma with widespread metastases. A computerized tomography scan of the left hip revealed a metastatic lesion at the left proximal femur.

DISCUSSION

Physical therapists' ability to adequately screen for conditions requiring examination by a physician can lead to a more timely diagnosis of serious medical conditions. Investigators have found published descriptions of end feels, capsular versus noncapsular patterns of restriction, and the sign of the buttock to be beneficial screening tools for use in people with hip, pelvis, or lumbar spine pain.

Ruptured abdominal aortic aneurysm presenting as testicular pain

A 70-year-old man presented with severe right testicular pain radiating to the groin, and was admitted under the urologist. A kidney, ureter and bladder CT scan showed a leaking abdominal aortic aneurysm (AAA). The presentation, nature and management of a leaking AAA are reviewed.

Differential diagnosis of a patient referred to physical therapy with low back pain: abdominal aortic aneurysm

STUDY DESIGN

Resident's case problem.

BACKGROUND

A 38-year-old man with a history of chronic episodic low back pain (LBP) was referred to physical therapy by his physician.

DIAGNOSIS

Concerns ascertained from the patient's history included an insidious onset of unrelenting, deep, boring pain that was constant, irrespective of movements or posture changes, or time of day. In addition, the patient reported night pain and the inability to find relief in recumbent positions. The primary warning signs associated with the physical examination were unremarkable examination of the lumbar spine, pelvis, and hip regions (symptoms not altered and minimal impairments detected), and a strong nontender, palpable pulse noted over the left lateral lumbar region, with the patient prone, and over the midline and left upper/lower abdominal quadrants, with the patient supine. Suspicion of the presence of an abdominal aortic aneurysm led the therapist to immediately refer the patient to an allopathic physician. The subsequent abdominal ultrasound and computed tomography scanning revealed a 10-cm-diameter abdominal aortic aneurysm. The patient was immediately hospitalized and underwent surgical repair within two days.

DISCUSSION

LBP is the most frequent condition for patients seeking care from physical therapists in outpatient settings. The challenge for clinicians is to recognize patients in whom LBP may be related to underlying pathological conditions. A prompt referral of patients presenting with suspicious findings to the appropriate physician may lead to a more timely diagnosis, with the goal of minimizing or preventing morbidity and mortality.

A rare case of leaking abdominal aneurysm presenting as isolated right testicular pain

An abdominal aortic aneurysm (AAA) is not usually considered in the differential diagnosis of isolated right testicular pain. We describe a patient who did present with isolated acute right testicular pain as the sentinel feature of a leaking AAA. In the patient group with right testicular pain, consideration of a leaking AAA should be added to the differential diagnosis. An adverse outcome can be avoided by timely diagnosis and intervention.