Aortoiliac occlusive disease

Case contributed by Henry Knipe
Diagnosis almost certain


Worsening lower back and leg pain over the last 3 days - only able to ambulate 5 meters.

Patient Data

Age: 50 years
Gender: Male

Minor lumbar intervertebral disc bulge. Central canal and neural exit foramina are capacious. No neural compressive lesion. No suspicious bone lesion.

Loss of normal T2 flow void the aorta with appearances suggestive of mural thrombus and occlusion. 

There is occlusion of the abdominal aorta from the level of the renal arteries through to the mid common iliac arteries bilaterally. Re-opacification just proximal to the external and internal iliac bifurcation. No cardiomegaly or pericardial effusion

The SMA is patent. The right and left renal arteries are patent however just distal to the left renal artery origin there is complete thrombosis of the abdominal aorta. The IMA origin is occluded however there is evidence of reconstitution of the proximal IMA from collaterals.

Case Discussion

The cause of occlusion is not clear although the aorta at the bifurcation is narrow in caliber with adjacent atherosclerotic calcification - this is the typical initial location of occlusion with thrombus propagating both distally and proximally. 

The key learning point is that check areas on lumbar spine MRI are vital - there are a myriad of causes of low back pain outside the spine with aortic disease just one of many. 

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