Point of Care Ultrasound Identifies Infrarenal Abdominal Aortic Aneurysm in A Patient with Atypical Shoulder Blade Pain: A Case Report

Marissa Benbassat MD, Reza Abdoli, Marcos Reyes, Heesun Choi DO

Received : October 25, 2025 | Published : December 19, 2025

Citation: Benbassat M, Abdoli R, Reyes M, Choi H. Point of Care Ultrasound Identifies Infrarenal Abdominal Aortic Aneurysm in A Patient with Atypical Shoulder Blade Pain: A Case Report. J Case Rep Rev Med. 2025;1(4):1-3. DOI: 10.64978/jcrrm-0117

Abstract

Introduction: Aortic dissection is a rare but potentially catastrophic vascular emergency. It is characterized by an intimal tear of the aorta, leading to a false lumen that may cause complications. While the majority of ADs occur in the thoracic aorta, the ones confined to the abdominal aorta are extremely rare and present different diagnostic and management challenges due to atypical symptoms and delayed recognition. The risk factors for abdominal aortic dissections include hypertension, atherosclerosis, connective tissue disorders, trauma, and congenital anomalies. Using bedside POCUS in patients presenting with atypical pain may appropriately prompt additional imaging, including CTA, which is not typically pursued for shoulder pain. Timely diagnosis with modalities such as POCUS or CTA is crucial, as delayed recognition can lead to significantly higher morbidity and mortality.

This is a case of a 75-year-old female presenting with an extensive type B intramural hematoma extending to the para-visceral segment and a 5 cm infrarenal abdominal aortic aneurysm. It highlights the challenge in the management of this rare vascular pathology and underlines early recognition and multidisciplinary intervention as key to favorable outcomes.

Case report: A 75-year-old female presented to the emergency department with sudden-onset back pain that began at 5:00 p.m. The pain was initially localized between her shoulder blades but progressively involved her entire spine. She also reported associated shortness of breath. Initial vital signs were significant for hypertension, with other parameters within normal limits. Physical examination revealed a patient in acute distress due to severe pain, but was otherwise unremarkable. This prompted bedside POCUS as part of the initial evaluation, which demonstrated findings concerning for an aortic aneurysm. A subsequent CTA obtained in the emergency department revealed an acute-on-chronic process with mural ulceration and likely penetrating atherosclerotic ulcers, with blood dissecting into the aortic wall.

Conclusion: The diagnosis of an aortic aneurysm is particularly concerning as it can lead to an aortic dissection which requires swift surgical intervention. Presentations can range from severe pain in the chest, upper back, or abdomen. The pain can radiate to the neck and shoulders. The two primary avenues for treatment include either surgical intervention, endovascular aortic repair, or medical management.