Letters To The Editor

Medical causes of back pain

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To the Editor: In their otherwise excellent review, “ Masquerade: Medical causes of back pain ” ( Cleve Clin J Med 2007; 74:905–913), Dr. Klineberg et al seem to confuse two distinct pathologic processes—aortic dissection and rupture of an aortic aneurysm. Parts of their description seem to fit the pathology of abdominal aortic aneurysm, with a pulsatile abdominal mass, sentinel bleeding, and rupture risk with a size over 6 cm, whereas other parts seem to correspond to aortic dissection, with severe, ripping pain and an association with Marfan syndrome. They also use the terminology “dissecting aortic aneurysm,” which again implies a single entity, when in fact the two conditions rarely occur together. The authors are not alone in their use of this misnomer: a review of the Web sites of renowned universities reveals use of the same terminology. The readers would have been better served if the authors had discussed “acute aortic dissection” and “ruptured aortic aneurysm” as two separate causes of back pain, with a note that in rare cases an aortic aneurysm can develop a dissection.

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