Soft-tissue images. Abdominal aortic aneurysm causing lumbar plexus neuropraxis

Philip I. Haigh; Andrew Maitland

A 71-year-old man, a smoker who had no history of peripheral vascular or cardiac disease experienced sudden excruciating pain in the left anterolateral thigh and numbness radiating to the lateral aspect of his knee. The pain was intensified by minimal movement of the hip and knee. Examination revealed a large expansile epigastric mass. Left femoral and popliteal pulses were absent. Sensation to his left anterolateral thigh was decreased as was quadriceps strength and the knee jerk reflex. Infusion abdominal computed tomography (Fig. 1) showed a large infrarenal abdominal aortic aneurysm, 11 cm in anteroposterior and transverse dimensions, with expansion to the left iliac fossa, lateral deviation of the psoas muscle and erosion of the fourth lumbar vertebral body. At operation, an inflammatory aneurysm was resected and reconstituted with a bifurcated Dacron graft. Extensive thrombus was removed from the left iliac fossa, and chronic erosion of the lumbar vertebrae was confirmed. Eight weeks after discharge, the patient was hospitalized briefly with new-onset atrial fibrillation. His thigh pain and numbness had improved markedly and he was walking with only minor difficulty.

FIG. 1

Footnotes

Section Editors: David P. Girvan, MD, and Nis Schmidt, MD
Submissions to Surgical Images,soft-tissue section, should be sent to Dr. David P. Girvan, Victoria Hospital Corporation, PO Box 5375, Station B, London ON N6A 5A5 or to Dr. Nis Schmidt, Department of Surgery, St. Paul’s Hospital, 1081 Burrard St., Vancouver BC V6Z 1Y6.