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Table of Contents
CASE REPORT
Year : 2017  |  Volume : 9  |  Issue : 2  |  Page : 192-193  

Leaking abdominal aortic aneurysm mimicking ureteric colic: So rare but so real in Middle East


Department of Urology, King Hamad University Hospital, Al Sayh, Kingdom of Bahrain

Date of Submission27-Aug-2016
Date of Acceptance14-Dec-2016
Date of Web Publication10-Apr-2017

Correspondence Address:
Tanweer Ahmed Naveed Bhatty
King Hamad University Hospital, Al Sayh
Kingdom of Bahrain
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DOI: 10.4103/0974-7796.204177

PMID: 28479776

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   Abstract 

Aortic aneurysms are very rare in Middle East unlike Europe and America. Therefore, this pathology is very likely to be missed in acute presentation to the Emergency Medicine Department. We present a case of leaking abdominal aortic aneurysm mimicking right ureteric colic, which was missed in the initial assessment.

Keywords: Acute aortic dissection, computerized tomogram, Emergency Medical Department


How to cite this article:
Bhatty TA, Chaudhry QS, Khan Z, Bastawicy AN. Leaking abdominal aortic aneurysm mimicking ureteric colic: So rare but so real in Middle East. Urol Ann 2017;9:192-3

How to cite this URL:
Bhatty TA, Chaudhry QS, Khan Z, Bastawicy AN. Leaking abdominal aortic aneurysm mimicking ureteric colic: So rare but so real in Middle East. Urol Ann [serial online] 2017 [cited 2020 Sep 26];9:192-3. Available from: http://www.urologyannals.com/text.asp?2017/9/2/192/204177


   Introduction Top


Aortic aneurysms are very rare in Middle East. Sometimes presentation is very close to ureteric colic, so they are likely to be missed. We present a case of leaking abdominal aortic aneurysm mimicking right ureteric colic, which was missed in the initial assessment. Our case report will help emergency physician and urologist to remember this life threatening condition as one of differential diagnosis in high risk patients.


   Case Report Top


A 61-year-old male Bahraini who was smoker and known case of hypertension and dyslipidemia, presented twice in the Emergency Medical Department (EMD), with acute right loin pain radiating to groin. Pain was moderate with a score of 5/10, continuous with little dysuria. In EMD, his blood pressure (BP) was 148/90 mmHg and varied between 118/66 and 179/148 mmHg during admission. His heart rate (HR) was 76/min. Rest of the vitals were stable. Examination was unremarkable. Creatinine was 124.7 μmol/L. His hemoglobin was 10.4 g/dl and remained stable. His white blood cell count was raised to 16.56 × 103/μL (range 3.6–9.6) and urine revealed 18–20 red blood cells. He was admitted with a provisional diagnosis of right ureteric colic. Noncontrast computerized tomogram (CT) was reported negative for urolithiasis, but positive findings were gallstones, enlarged left suprarenal gland with large retrocaval and paraaortic lymph nodes along with spondylolysis L4–L5 vertebra [Figure 1]. Hence, contrast CT was done which reported aortic aneurysm arising from right lateral wall of distal aorta measuring 2.5 cm × 2.5 cm with its neck measuring 1.1 cm associated with hyperdense area 5.6 cm × 5.4 cm × 3.2 cm on its right side with no active contrast extravasation along with left adrenal adenoma 1.2 cm in size along with paraaortic lymph node 2 cm in size [Figure 2]a and [Figure 2]b. Vascular team was informed immediately and patient was shifted under their care with stable vital signs and BP of 129/80 mmHg and HR of 62/min.
Figure 1: Coronal view of computerized tomogram

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Figure 2: (a) Reconstruction view. (b) With contrast

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   Discussion Top


Incidence of acute aortic dissection (AAD) is 0.3% in patients attending EMD with complaint of back pain.[1] AAD is notorious for being missed as it can mimic many other acute conditions.[2] It can be missed in up to 38% patients on initial assessment and is found on postmortem examination in up to 28% of patients.[3] AAD is a life-threatening emergency and delay in diagnosis and treatment has serious consequences with very high mortality of 1–2%/h of delay.[4] The clinical predictors or risk factors are hypertension, Marfan syndrome, male sex, and advanced age.[5] Smoking is associated with 3–5 times increased risk of having aortic aneurysms.[6] There is no single diagnostic modality which can accurately diagnose AAD. However, contrast CT is the best with 92%–96% diagnostic accuracy.[7]


   Conclusions Top


Leaking abdominal aortic aneurysm is very rare but a real possibility in Middle East as we have seen in our case. Even in western world, where it is more common, it is missed in about one-third of cases, resulting in a very high mortality. Hence, it must not be forgotten and should always be included in the differential diagnosis, especially if risk factors exist.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
   References Top

1.
Tsai TT, Trimarchi S, Nienaber CA. Acute aortic dissection: Perspectives from the International Registry of Acute Aortic Dissection (IRAD). Eur J Vasc Endovasc Surg 2009;37:149-59.  Back to cited text no. 1
    
2.
Rapezzi C, Longhi S, Graziosi M, Biagini E, Terzi F, Cooke RM, et al. Risk factors for diagnostic delay in acute aortic dissection. Am J Cardiol 2008;102:1399-406.  Back to cited text no. 2
    
3.
von Kodolitsch Y, Schwartz AG, Nienaber CA. Clinical prediction of acute aortic dissection. Arch Intern Med 2000;160:2977-82.  Back to cited text no. 3
    
4.
Hagan PG, Nienaber CA, Isselbacher EM, Bruckman D, Karavite DJ, Russman PL, et al. The International Registry of Acute Aortic Dissection (IRAD): New insights into an old disease. JAMA 2000;283:897-903.  Back to cited text no. 4
    
5.
Shirakabe A, Hata N, Yokoyama S, Shinada T, Suzuki Y, Kobayashi N, et al. Diagnostic score to differentiate acute aortic dissection in the emergency room. Circ J 2008;72:986-90.  Back to cited text no. 5
    
6.
Fleming C, Whitlock EP, Beil TL, Lederle FA. Screening for abdominal aortic aneurysm: A best-evidence systematic review for the U.S. Preventive Services Task Force. Ann Intern Med 2005;142:203-11.  Back to cited text no. 6
    
7.
Salvolini L, Renda P, Fiore D, Scaglione M, Piccoli G, Giovagnoni A. Acute aortic syndromes: Role of multi-detector row CT. Eur J Radiol 2008;65:350-8.  Back to cited text no. 7
    


    Figures

  [Figure 1], [Figure 2]



 

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