Aortic aneurysm producing back pain, bone destruction, and paraplegia

Back pain and paraplegia are uncommon presenting symptoms/signs of aortic aneurysms. Extensive destructive changes were noted in the lower lumbar vertebrae in a 79-year-old man with an aneurysm that had eroded into the spine. The association of back pain with vertebral body erosion requires evaluation for vertebral or paravertebral abscess, neoplasia, and aortic aneurysm. Arteriography is usually required to demonstrate continuity with the vertebral body and to exclude the coincidental association of an aortic aneurysm with another pathology, i.e., neoplasm. Aggressive surgical treatment is recommended for any rapidly expanding aneurysm. The natural history of the untreated lesion is one of rapid demise.