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Old 02-11-2013
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Question Weird Case; Anything other than AAA

A 73 year old woman presenting to vascular clinic for routine follow up for AAA - discovered by an abdominal ultrasound 2 years ago before laparoscopic cholecystectomy. The last measurement(6 months ago) of AAA size was 4.0 cm. In clinic, the patient reports with recent back pain in last 2 weeks. Other than that the patient is a jogger and exercise avidly. He's a heavy smoker and a retired accountant. Her bp is average 150/90 measured at home.
History: 20 years of hypertension, hysterectomy was done 15 years ago, heart attack-5 years ago-had PTCA performed.
Medication: ACE-I, aspirin, statin, B-blocker

What's the most likely diagnosis?


This is the question I got from my doc, I think the answer is the back pain is related to the worsening of the AAA..? Or anyone has other thoughts toward this case?
Thanks!
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Old 02-11-2013
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Sex change operation leading to back pain due to osteoporosis due to hormonal imbalance (Lack of estrogen).
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Differentials;
-it may be symptomatic AAA
-what was the reason for hysterectomy? maybe there are metastasis to the bones?
-osteoporosis
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Old 02-11-2013
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Jokes apart, she has an expanding AAA because:


Constant low back pain with risk factors:

1. Older than 65 years
2. H/O atherosclerotic vascular disease (h/o MI & PTCA)
3. Heavy smoking,
4. and hypertension (150/90)
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