A case of "tearing" back pain and acute limb ischaemia

doi:10.1136/bmj.a3114

Published 4 February 2009, doi:10.1136/bmj.a3114
Cite this as: BMJ 2009;338:a3114

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A case of "tearing" back pain and acute limb ischaemia

R Allison, specialist registrar in radiology¹, M G Wyatt, consultant vascular surgeon², R Williams, consultant interventional radiologist¹

¹ Department of Interventional Radiology, Freeman Hospital, Newcastle upon Tyne NE7 7DN, ² Department of Vascular Surgery, Freeman Hospital

Correspondence to: M G Wyatt mike.wyatt@nuth.nhs.uk

The first 150 words of the full text of this article appear below.

A 50 year old man presented to his local accident and emergencydepartment with sudden onset of severe "tearing" interscapularback pain and a cold white insensate left leg. At initial assessmenthe had pronounced hypertension, an ischaemic left leg, and animpalpable left femoral pulse. His medical history was unremarkable.An urgent computed tomography angiogram was obtained (fig 1).

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Fig 1 Three dimensional reconstruction from the computed tomography angiogram showing the aortic arch and the iliac bifurcation

1 What is the diagnosis?

2 What is the most common classificationsystem, and how wouldyou classify this case?

3 What complicationdoes the patient have?

4 What are the treatment options?

1 The angiogram shows a thoracic aortic dissection (fig 2

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Fig 2 Three dimensional reconstruction from the computed tomography angiogram showing the aortic arch and the iliac bifurcation. The left arrow shows the intimal flap and the . . . [Full text of this article]