Introduction
An abdominal aortic aneurysm (AAA) is a permanent dilatation of the
infrarenal aorta that is 3 cm or greater in diameter or equivalent to
1.5 times the normal anteroposterior diameter. Risk factors for AAA
include smoking, male sex, age greater than 65 years old, high systolic
blood pressure (SBP), high body mass index (BMI), high serum
triglycerides, high low-density lipoprotein (LDL), family history of
AAA, coronary artery disease (CAD), atherosclerosis, stroke, and
diabetes mellitus with concomitant CAD and peripheral artery disease
(PAD). Of these, smoking is the greatest contributor to the development
of AAA. In smokers, growth rate increases by an additional 0.35 mm/year
and rupture rate doubles. Most unruptured AAA are asymptomatic and are
found incidentally while investigating some other pathology. However,
when symptomatic, unruptured AAA may present with unexplained abdominal
discomfort and pain that radiates to the back, flank, or groin, as well
as a pulsatile abdominal mass with or without a bruit heard at the mass.
The generalized pain from a symptomatic AAA may be confused with an
orthopaedic etiology. A patient presenting with what seems to be a
musculoskeletal (MSK) concern may logically lead a clinician towards a
MSK differential diagnosis. However, it is important for orthopaedic
clinicians to consider other etiologies when examining a patient in
order to avoid missed diagnoses. In this case report, we discuss a case
of an AAA incidentally found during an orthopaedic workup for posterior
hip and low back pain. Our objectives are 1) to increase awareness of an
AAA presenting as orthopaedic concerns and 2) to highlight the
importance of a thorough history and a holistic physical exam in the
orthopaedic clinic.