Fillers An unusual occurrence

“I can't turn my car to the left”

BMJ 1998; 316 doi: (Published 07 March 1998) Cite this as: BMJ 1998;316:786
  1. Michael Oliver, emeritus professor in cardiology
  1. London

    “When I turn the car sharply to the left I feel a sort of grating in my back. The problem is that there is an acute turn to the left from my rough little road into the main road.” This intelligent, 54 year old woman had no other complaints or comments, except that “it occurs so often now that I have decided to turn to the right out of my road and go in the opposite direction for a few hundred yards, then reverse into a drive way and turn back in the direction I wanted to go. It is not painful and the grating stops as soon as I straighten up the car. The first time I noticed it was when making a U turn from right to left some two months ago.” It did not occur at any other time and seemed only to be associated with vibration and rough roads.

    Evidently, the general practitioner thought little of her story and asked me to see her because of a blood pressure of 160/100 mm Hg. He had previously sent her to an orthopaedic consultant who did not find any spinal explanation for her symptoms. I was not able to elicit any other features from her history, except to confirm that the sensation never occurred when she turned her car from left to right and that it never occurred at any other time. She was adamant that it had something to do with driving on rough roads.

    She was a fit looking woman who played tennis regularly, who had two teenage children, and seemed happily married to a farmer. In fact, her blood pressure on repeated readings was never more than 145/92 mm Hg. There was only one possible abnormal clinical finding and this was arterial pulsation in the upper abdomen, but she was thin and this might have been normal: femoral and peripheral pulses were normal. All cardiovascular investigations including a maximum exercise tolerance test were normal. But a posteroanterior x ray examination and ultrasound of the area of abdominal pulsation showed a mass to the left of T11 and T12, and subsequent aortography showed a fusiform aneurysm. It was projecting 2 cm laterally from the aortic wall and seemed to contain clot.

    At surgery, the aneurysm extended 4 cm in length and 2.5 cm laterally to the left of the aorta. It was possible to remove it with temporary occlusion of the aorta and replace it with a prosthetic graft.

    The specimen showed that there had been some dissection into the media, possibly with return into the lumen; it also contained dense clot. The cause of this localised aortic aneurysm was unknown. There had been no trauma in the region.

    Presumably the patient compressed the aneurysm when turning her car to the left. She has had no further symptoms and can now drive her car in all directions.

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