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Clinical Images

Back Pain and an Abnormal Abdominal X-Ray

Babak Abai, MD
Drew L. Kotler, BA 
Michael J. Pucci, MD
Adam C. Winters, BS

September 26, 2014

A 68-year-old male with hypertension and a prior appendectomy presented to our institution with a two-week history of sharp, intermittent back and abdominal pain. The pain responded minimally to non-steroidal anti-inflammatory drugs. The patient denied change in bowel habits or a recent history of trauma. The patient was a former smoker with a 20 pack-year smoking history. A focused physical exam revealed clear lungs, a normal heart exam and a soft, non-tender, non-distended abdomen. Routine laboratory work was within normal limits. An abdominal x-ray was obtained (Figure 1). A subsequent CT angiogram confirmed the diagnosis of abdominal aortic aneurysm (AAA) with a diameter of 4.9 cm (Figure 2).

(Figure 1)

(Figure 2)


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Author bios:

Drew Kotler and Adam Winters are both 4th year Medical Students at Sidney Kimmel Medical College at Thomas Jefferson University.  Both are entering residencies in Internal Medicine.

Dr. Babak Abai is an Assistant Professor of Surgery specializing in Vascular Surgery at Thomas Jefferson University.

Dr. Michael Pucci is an Assistant Professor of Surgery specializing in Minimally Invasive Surgery at Thomas Jefferson University.


1.Palazzuoli A, Gallotta M,  Guerrieri G, et al. Prevalence of risk factors, coronary and systemic atherosclerosis in abdominal aortic aneurysm: comparison with high cardiovascular risk population. Vasc Health Risk Manag. 2008;4(4): 877

2. Brewster DC, Cronenwett, JL, Hallett J, et al. "Guidelines for the treatment of abdominal aortic aneurysms: report of a subcommittee of the Joint Council of the American Association for Vascular Surgery and Society for Vascular Surgery." J Vasc Surg  2003;37(5): 1106-1117

3. A Dunne, Jonathan, et al. "Statins: the holy grail of Abdominal Aortic Aneurysm (AAA) growth attenuation? A systematic review of the literature." Current vascular pharmacology 12.1 (2014): 168-172.

Figure 1. Abdominal x-ray demonstrating an abdominal mass with calcified rim. 
Figure 2. Coronal computed tomography scan demonstrating an infrarenal abdominal aortic aneurysm.