In two men presenting with atypical vertebrogenic-like pain, early imaging confirmed acute aortic syndromes, resulting in one survival after elective repair and one death after emergency surgery.
Case Report (n=2)
Atypical vertebrogenic-like pain can conceal underlying life-threatening aortic pathology, highlighting the critical need for early imaging and a high index of suspicion.
RATIONALE: Acute aortic syndromes, including dissection and aneurysm, are life-threatening vascular emergencies that often present with vague, nonspecific pain. Such pain may mimic common musculoskeletal or visceral disorders such as vertebrogenic, renal, or gastrointestinal pain, leading to diagnostic delays and adverse outcomes. This case series underscores how atypical vertebrogenic-like pain can conceal underlying aortic pathology and highlights the importance of early imaging in suspicious cases. PATIENT CONCERNS: A 56-year-old man with descending thoracoabdominal aortic aneurysm, and 35-year-old man with Stanford Type A ascending aortic dissection. DIAGNOSES: CT angiography of the aorta due to persistent vertebrogenic back pain despite treatment of lumbar spine pathology revealing a large descending thoracoabdominal aortic aneurysm. In second case a CT scan of the cervical and thoracic spine performed after persistent pain despite cervical vertebrogenic syndrome analgesics treatment led to aortic dissection confirmation. INTERVENTIONS: Elective surgical repair of aneurysm via thoraco-phreno-laparotomy. The aneurysm was resected and replaced with a 22-mm aorto-aortic Dacron graft. In second case, an emergency surgery with veno-arterial extracorporeal membrane oxygenation support with an open chest due to ongoing uncontrollable hemorrhage was provided. OUTCOMES: Patient was discharged on postoperative day 7 in stable condition. A second patient passed away of early complications as systemic inflammatory response syndrome, acute renal failure, and circulatory shock. LESSONS: These cases emphasize the diagnostic challenges of aortic pathologies in the context of misleading clinical features. Physicians must maintain a high index of suspicion for acute aortic syndromes, particularly when encountering atypical or refractory pain in patients with cardiovascular risk factors. Early diagnosis and adherence to guideline-based management are critical to improving survival in these high-risk emergencies.
Kočan et al. (Fri,) conducted a case report in Acute aortic syndromes (n=2). Surgical repair was evaluated on Clinical outcome. In two men presenting with atypical vertebrogenic-like pain, early imaging confirmed acute aortic syndromes, resulting in one survival after elective repair and one death after emergency surgery.
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