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Large sized common iliac artery aneurysm with thrombus developing a diagnostic confusion in a patient with sciatica.

Jeon IC, Kim SW, Jung YJ - Korean J Pain (2014)

Bottom Line: The causes of sciatica are variable and include musculoskeletal, dermatologic, infectious, neoplastic, and vascular disorders.In many cases, the symptom is usually caused by degenerative disease in the spine with the compression or irritation of spinal nerve.Among the extra-spinal cases, aneurysms arising from iliac vessels are sometimes developing a diagnostic confusion with the spinal causes, and delayed diagnosis can lead to poor prognosis.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurosurgery, College of Medicine, Yonsei University Gangnam Severance Hospital, Seoul, Korea.

ABSTRACT
The causes of sciatica are variable and include musculoskeletal, dermatologic, infectious, neoplastic, and vascular disorders. In many cases, the symptom is usually caused by degenerative disease in the spine with the compression or irritation of spinal nerve. On the other hands, there are also several announced extra-spinal causes including aneurysm, diabetes, and radiation for sciatica in a low rate. Among the extra-spinal cases, aneurysms arising from iliac vessels are sometimes developing a diagnostic confusion with the spinal causes, and delayed diagnosis can lead to poor prognosis. It is very important to pay attention weather the aneurysmal cause is involved in the symptom of sciatica.

No MeSH data available.


Related in: MedlinePlus

Non-contrast magnetic resonance imaging (MRI) of the lumbar spine. Axial T2-weighted images (A) show disc bulging and left foraminal and subarticular stenosis of L4-5. There is a large sized aneurysm with thrombus (white arrow) arising from left common iliac artery of L5 body level with irritating the surrounding lumbosacral plexus (red arrow) on axial (B) and sagittal (C) images. Thrombus inside of the aneurysm shows a tendency to grow compare to previous MRI (D) at the first-visit hospital.
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Figure 1: Non-contrast magnetic resonance imaging (MRI) of the lumbar spine. Axial T2-weighted images (A) show disc bulging and left foraminal and subarticular stenosis of L4-5. There is a large sized aneurysm with thrombus (white arrow) arising from left common iliac artery of L5 body level with irritating the surrounding lumbosacral plexus (red arrow) on axial (B) and sagittal (C) images. Thrombus inside of the aneurysm shows a tendency to grow compare to previous MRI (D) at the first-visit hospital.

Mentions: An 80-year-old female patient who has a history of taking agents for hypertension and diabetes mellitus (The patient personally discontinued the medications two weeks ago) for more than 20 years was transferred to our emergency room from another medical center with sudden developed dyspnea and drowsy consciousness. She presented abdominal distension and hypovolemic status with 85 mmHg systolic blood pressure. The patient had visited two other hospitals and magnetic resonance imaging (MRI) for lower back pain and left sciatica which were developed three months ago had been performed respectively. The leg symptom was dominant on L4 and 5 dermatomes, but specific and definite dermatome was not noted. The straight leg raise test and the sign of myelopathy showed negative results. In each hospital, she received several times of epidural block under the impression of left neural foraminal and subarticular stenosis on L4-5 (Fig. 1A). The symptom was sustained by a shortening of interval and an increasing of intensity, although there were some alleviations of the symptom immediately after the procedures. She developed sudden and severe abdominal pain while staying in a rest room after a left L4 and 5 selective transforaminal epidural block using triamcinolone and bupivacaine at the second-visit hospital. There were no abnormal signs related with procedure and chemical laboratory studies except mild elevation of serum creatinine (1.46 mg/dl). The abdominal pain was aggravated without any alleviation under painkillers and she was transferred to our emergency room. Whole abdominal computed tomography (CT) was performed for evaluating abdominal symptom and it revealed a huge hematoma presenting as a leakage of dye on the retroperitoneal space with calcified large sized fusiform aneurysm containing thrombus and arising from the left common iliac artery (Fig. 2).


Large sized common iliac artery aneurysm with thrombus developing a diagnostic confusion in a patient with sciatica.

Jeon IC, Kim SW, Jung YJ - Korean J Pain (2014)

Non-contrast magnetic resonance imaging (MRI) of the lumbar spine. Axial T2-weighted images (A) show disc bulging and left foraminal and subarticular stenosis of L4-5. There is a large sized aneurysm with thrombus (white arrow) arising from left common iliac artery of L5 body level with irritating the surrounding lumbosacral plexus (red arrow) on axial (B) and sagittal (C) images. Thrombus inside of the aneurysm shows a tendency to grow compare to previous MRI (D) at the first-visit hospital.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4196502&req=5

Figure 1: Non-contrast magnetic resonance imaging (MRI) of the lumbar spine. Axial T2-weighted images (A) show disc bulging and left foraminal and subarticular stenosis of L4-5. There is a large sized aneurysm with thrombus (white arrow) arising from left common iliac artery of L5 body level with irritating the surrounding lumbosacral plexus (red arrow) on axial (B) and sagittal (C) images. Thrombus inside of the aneurysm shows a tendency to grow compare to previous MRI (D) at the first-visit hospital.
Mentions: An 80-year-old female patient who has a history of taking agents for hypertension and diabetes mellitus (The patient personally discontinued the medications two weeks ago) for more than 20 years was transferred to our emergency room from another medical center with sudden developed dyspnea and drowsy consciousness. She presented abdominal distension and hypovolemic status with 85 mmHg systolic blood pressure. The patient had visited two other hospitals and magnetic resonance imaging (MRI) for lower back pain and left sciatica which were developed three months ago had been performed respectively. The leg symptom was dominant on L4 and 5 dermatomes, but specific and definite dermatome was not noted. The straight leg raise test and the sign of myelopathy showed negative results. In each hospital, she received several times of epidural block under the impression of left neural foraminal and subarticular stenosis on L4-5 (Fig. 1A). The symptom was sustained by a shortening of interval and an increasing of intensity, although there were some alleviations of the symptom immediately after the procedures. She developed sudden and severe abdominal pain while staying in a rest room after a left L4 and 5 selective transforaminal epidural block using triamcinolone and bupivacaine at the second-visit hospital. There were no abnormal signs related with procedure and chemical laboratory studies except mild elevation of serum creatinine (1.46 mg/dl). The abdominal pain was aggravated without any alleviation under painkillers and she was transferred to our emergency room. Whole abdominal computed tomography (CT) was performed for evaluating abdominal symptom and it revealed a huge hematoma presenting as a leakage of dye on the retroperitoneal space with calcified large sized fusiform aneurysm containing thrombus and arising from the left common iliac artery (Fig. 2).

Bottom Line: The causes of sciatica are variable and include musculoskeletal, dermatologic, infectious, neoplastic, and vascular disorders.In many cases, the symptom is usually caused by degenerative disease in the spine with the compression or irritation of spinal nerve.Among the extra-spinal cases, aneurysms arising from iliac vessels are sometimes developing a diagnostic confusion with the spinal causes, and delayed diagnosis can lead to poor prognosis.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurosurgery, College of Medicine, Yonsei University Gangnam Severance Hospital, Seoul, Korea.

ABSTRACT
The causes of sciatica are variable and include musculoskeletal, dermatologic, infectious, neoplastic, and vascular disorders. In many cases, the symptom is usually caused by degenerative disease in the spine with the compression or irritation of spinal nerve. On the other hands, there are also several announced extra-spinal causes including aneurysm, diabetes, and radiation for sciatica in a low rate. Among the extra-spinal cases, aneurysms arising from iliac vessels are sometimes developing a diagnostic confusion with the spinal causes, and delayed diagnosis can lead to poor prognosis. It is very important to pay attention weather the aneurysmal cause is involved in the symptom of sciatica.

No MeSH data available.


Related in: MedlinePlus