Mr. He (pseudonym), 64 years old this year, just retired, and he was unable to rest and was able to clear up wasteland not far from his home. One day, when he was lifting the fertilizer, he suddenly felt pain and soreness and swelling of his right lower limbs, which continued to relieve. Because I couldn't bear it, I let my partner go to the hospital with me.
After arriving at the hospital, I listened to Master He’s self-report, and the doctor initially considered that lumbar disc herniation , so I arranged for CT to check , and it was found that lumbar disc herniation 4/5.
"Acute lumbar disc herniation can only be treated with medication to relieve pain!" The doctor told Master He this way. So the doctor prescribed some painkillers to Master He. However, after simple drug treatment, it could not be relieved. In desperation, the old couple urgently sought help again and came to the higher hospital.
After receiving the treatment, the emergency orthopedic surgeon of the superior hospital saw a CT scan performed by Master He in the local hospital. He also initially considered that it was a lumbar disc herniation, so he gave outpatient infusion to relieve pain and relieve edema. During the infusion in the outpatient observation room, the old man said that the pain in the right lower limb had improved during the doctor's inspection.
lumbar disc herniation
During the period, the doctor asked about the medical history in detail. It turned out that Master He found abdominal aortic aneurysm during the physical examination of the unit 5 years ago, but the diameter was not large. The doctor recommended follow-up.
Doctor He heard that Master He had such a medical history and dared not be careless, because if the abdominal aortic aneurysm ruptures or becomes larger and compresses the iliac blood vessels, it will also cause pain in the lower limbs. So Lao He quickly asked him to rescan the following abdominal CT, and found that the abdominal aortic aneurysm was 4.5 cm in diameter, not big, and there was no sign of rupture.
Abdominal aortic aneurysm
and after the doctor treated lumbar disc herniation , the patient's lower limb pain was significantly relieved, so he continued infusion and observation.
At this time, even Master He himself thought it was a simple lumbar disc herniation, and he could go back tomorrow after the infusion was relieved. As a result, at 2 a.m., pain in the right lower limbs appeared again.
The doctor on duty at this time came to check again and found that Lao He's right lower limb had obvious ischemia below the knee plane, and femoral artery , popliteal artery , dorsal foot artery, and posterior tibial artery did not touch .
"This may be an embolization of the lower limb artery!" the doctor thought to himself. In other words, Lao He did not suffer from lower limb pain caused by lumbar disc herniation, but because of blockage of blood vessels in the lower limbs.
quickly arranged for Lao He to perform angiography , and found that the abdominal aortic aneurysm had a wall thrombosis. The blood vessels distributed in the right thigh are not developed from below the right common iliac artery, and the right external iliac artery and femoral artery, which is an obvious manifestation of arterial embolism.
Vascular embolism
Preliminary consideration is thromboembolism at the bifurcation of the right external iliac artery. An emergency consultation for vascular surgery.
After consultation on vascular surgery, it was found that Lao He had serious ischemia in his right lower limb. If there is no emergency surgery, there may be more serious complications. So he immediately performed a right femoral artery incision, and then he aspirated the thrombus upward and downward respectively, and a large number of thrombus were drawn out. After checking that the blood vessels were sprayed well, the femoral artery was sutured and the operation was completed.
surgery was completed, and Lao He was also sent to ICU ( intensive care unit ). When entering the ICU, the doctor found that Lao He could not touch the artery pulsation of his right lower limb, and his blood supply was poor with the right lower limb. At the same time, he also had abnormal symptoms such as decreased urine volume and increased blood potassium.
After entering the ICU, Master He's condition worsened a lot, his right lower limb became severely hard, swollen, and tension bubbles appeared. When the doctor saw that this was compartment syndrome .
The so-called compartment syndrome is caused by the rapid increase in the pressure of the osteofascia formed by bone, interosseous membrane, intermuscular septum and deep fascia after the limb is traumatized, and the internal muscles and nerves are compressed, resulting in acute ischemia and hypoxia. It is manifested as local swelling and unbearable pain. If the incision and decompression treatment are not promptly cut, severe nerve and muscle necrosis will occur later.
The doctor immediately performed compartment syndrome incision and decompression, but the patient's condition still deteriorated rapidly. Later, it was recommended to amputate the right lower limb, but the family member's consent was not obtained and the procedure was not carried out.
ICU
On the third day after entering the ICU, Lao He left because of multiple organ failure. Afterwards, a death discussion was held because no cardiac embolic origin was found during a cardiac ultrasound examination, and the electrocardiogram also showed sinus rhythm , so the thrombus of the right lower limb embolization did not come from the heart. Then there is only one possibility, which is the clavicle thrombosis of abdominal aortic aneurysm.
It is worth noting that when both doctors diagnosed lumbar disc herniation, they did not conduct strict physical examinations. The most important diagnosis method for lumbar disc herniation is not imaging examination, but medical history, symptoms and physical examination. The pain in the lower limbs caused by lumbar disc herniation is mainly because the eccentric disc compresses the nerve roots, resulting in lower limb pain.
The pain caused by arterial thromboembolism is because the thrombus blocks blood vessels, causing ischemia of the lower limb artery and ischemia, and then numbness, swelling and pain. In addition, a typical feature of arterial embolism is that the lower limbs cannot touch strong arterial pulsation, and the lower limb skin temperature has decreased, so attention should be paid to the difference between pain caused by lumbar disc herniation.
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