Differential Diagnosis of a Patient Referred to Physical Therapy With Low Back Pain: Abdominal Aortic Aneurysm

Filippo Mechelli, Zachory Probaski, William G. Boissonnault

DOI: 10.2519/jospt.2008.2719

STUDY DESIGN: Resident's Case Report. 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 non-tender 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 an abdominal aortic aneurysm being present led the therapist to immediately refer the patient to an allopathic physician. The subsequent abdominal ultrasound and computed tomography scanning revealed a 10 centimeter diameter abdominal aortic aneurysm. The patient was immediately hospitalized and underwent surgical repair within two days. DISCUSSION: LBP is the most frequent complaint noted by patients seeking care from physical therapists in outpatient settings. The challenge for clinicians is to recognize patients whose 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. LEVEL OF EVIDENCE: Diagnosis, level 4.

J Orthop Sports Phys Ther., Epub 3 June 2008. doi:10.2519/jospt.2008.2719

KEY WORDS: aorta, medical screening, night pain, palpation, visceral back pain

A 38-year-old man with a history of chronic episodic low back pain (LBP) was referred to physical therapy by his physician. Suspicion of an abdominal aortic aneurysm being present led the therapist to immediately refer the patient to an allopathic physician. The subsequent abdominal ultrasound and computed tomography scanning revealed a 10 centimeter diameter abdominal aortic aneurysm.

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