Tearing Back Pain and an Aneurysmal Aorta
By Richard P. Holm MD
His wife almost had to force him to come to the emergency room. She said he was unusually irritable. Although he typically kidded with me, this evening the smile was gone. He complained of a tearing strain and pain into his back (along with a throbbing abdominal discomfort). On exam he had a pulsating abdominal mass and upon listening with the stethoscope I could hear a repeating and prominent whoosh. My patient didn’t have a back strain but rather a dissecting abdominal aortic aneurysm.
The aorta is the largest blood vessel which extends out the top of the heart feeding oxygenated blood to virtually every cell in the body. It is a multi-layered, high-pressure hose that arches upward and around, sending tributaries to neck and brain, arms and then down through the chest past the diaphragm. Once it reaches the abdomen, the aorta sends branches everywhere, including the bowels and kidneys before finally splitting into the two femoral arteries providing blood for the legs.
We measure the continuous pressure exerted within the aorta in millimeters of mercury, and has, on average, a systolic pressure of 120 and a diastolic pressure of 80. In a hypertensive person, this can be much higher. After years of increased pressure, and, especially after years of smoking, the walls of this mighty vessel can weaken and blood flow can split into one of the layers of the vessel, dissect the layers apart. A weakened aorta can also suddenly rupture, causing immediate death. Most victims are or were smokers and about two-thirds are male. The U.S. Preventive Services Task Force recommends that men aged 65–75 years who have ever smoked should get an ultrasound screening for abdominal aortic aneurysms, even if they have no symptoms. In my practice I listen, especially to every past smoker, male or female, for an abdominal whoosh.
More than 15,000 Americans die from this condition each year with the incidence tripling over the last 30 years due to the aging population and the history of smoking in that group. The death rate would be markedly less if proper screening occurred. My patient did not die; he made it to surgery and within hours a new lining to his aorta was provided.
Now, something like 10 years later, he is still alive and joking with me.
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