Mid-back pain due to a penetrating atherosclerotic aortic ulcer: do not miss the diagnosis-a case report.

Annals of Palliative Medicine
Jong Hyun BaekMin Cheol Chang

Abstract

In clinical practice, clinicians often meet patients suffering from mid-back pain. One of the possible causes of mid-back pain is penetrating atherosclerotic aortic ulcer (PAU), but the diagnosis is often delayed owing to its low incidence. Here, we report a patient with mid-back pain due to a PAU, who was diagnosed after receiving several procedures for reducing musculoskeletal pain. A 65-year-old man visited our pain clinic for mid-back pain [numeric rating scale (NRS): 7] experienced for 2 months. The pain was radiated to the lateral chest area and was aggravated when in the supine and standing positions. Trigger point injection, medial branch block, and pulsed radiofrequency were ineffective. The cardiac evaluation and abdominal computed tomography (CT) results showed no abnormalities. On CT aortography at 3 months after pain onset, intraluminal thrombus, multiple ruptured PAUs, and aneurysmal change of the descending thoracic aorta were found. Accordingly, PAU was diagnosed as the origin of the patient's pain. We administered nicardipine with a rate of 1.15 mcg/kg/min and esmolol with a rate of 100 mcg/kg/min for controlling the systolic blood pressure. In addition, an anticoagulant was administered orally. To alleviate th...Continue Reading

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