A man with lower back pain
A 66 year old man presented to his general practitioner with lower back pain, worsening over a three month period, which radiated into his abdomen. His history included hypertension and hypercholesterolaemia, and he was a long term smoker.
He was afebrile with a blood pressure of 132/84, heart rate 84, and oxygen saturations 96%. His GP requested a lumbar spine radiograph (figure) and blood tests—haemoglobin was 12.8g/dL, white cell count 6.4, Na+ 138, K+ 3.9, Cr 121, and Ur 6.6 mmol/L (the GP performed the radiograph as a firstline investigation for back pain. It is worth noting, however, that guidelines from the National Institute for Health and Clinical Excellence recommend against ordering a radiograph of the lumbar spine in lower back pain).
An AAA is a permanent dilatation of the abdominal aorta greater than 3 cm in diameter. Around 4% of men aged 65-74 are believed to have an AAA.