A Case of Aneurysm of the Abdominal Aorta

Abstract

Since cases of abdominal aneurysm in which the symptoms are suggestive of renal stone are rather infrequently encountered, and also because the aneurysm is rarely found to have penetrated through the diaphragm, it is believed that the following case history will be of interest. A man, 46 years of age, entered the Clinic complaining of “kidney trouble” and backache. The symptoms had been noticed, first, nine months previously, at which time he experienced pain in the kidney region of the left side and back, radiating downward to the flank, the distress persisting for several days. He had frequency but there was no hematuria. The pain had subsided after the patient's physician had given him a dose of medicine and he apparently remained well until five days before he entered the Clinic, when another attack occurred; since then, the pain had been severe and constant. Relief could be obtained only by standing and leaning to the left side. The patient had lost fifteen pounds in weight. The personal history revealed nothing of significance, and upon physical examination no gastro-intestinal symptoms were found to be present. There were no significant findings in the urologic examination, except for signs which led to the suspicion of an aneurysm of the left renal artery. There was no shortness of breath, no palpitation, no edema. The pulse rate was 120 and the blood pressure 150/100. A general examination of the chest showed nothing of significance and no masses could be palpated in the abdomen. A diagnosis was made of left kidney stone, neoplasm of the left kidney, arteriosclerosis and hypertension, and the patient was advised to enter the hospital. A roentgenographic examination of the abdomen by means of pneumoperitoneum disclosed a large abdominal aneurysm. On February 11, 1929, under spinal anesthesia, a left oblique lumbar incision was made and the left kidney exposed. No evidence of a tumor or a stone was found, but the lower pole of the kidney was soft. The kidney was removed. Just above the kidney area and beneath it, a pulsating mass could be seen from which dark blood flowed after a needle was inserted. This mass was believed to be an aneurysm of the abdominal aorta originating just below the diaphragm. As it was not possible to institute surgical treatment for this condition, the wound was closed. The patient made an uneventful recovery. On November 11, 1930, the patient returned to the Clinic complaining of pain in the left lumbar area from which he had suffered for several months. There was marked restriction of movement in the upper lumbar area. Roentgenographic examination showed the bodies of the first lumbar and the eleventh and twelfth dorsal vertebrae to be about half destroyed by the aneurysm. Marked right scoliosis was noted. On December 12, 1930, a roentgenographic examination of the gastro-intestinal tract showed no evidence of a pathologic condition either in the stomach or colon.