Differential Diagnosis
- Single most likely diagnosis
- Ruptured aortic aneurysm: The patient's severe midlumbar back pain, anxiety, pallor, diaphoresis, and tachycardia are classic symptoms of a ruptured aortic aneurysm. The presence of calcifications anterior to the vertebral bodies on X-ray films also supports this diagnosis, as they may represent calcified atheromas in the aortic wall.
- Other Likely diagnoses
- Aortoiliac occlusion: This condition can also cause severe back pain and may be associated with similar symptoms, but it is less likely given the acute onset and severity of the patient's presentation.
- Herniated nucleus pulposus: Although this condition can cause back pain, it is less likely to cause the systemic symptoms (anxiety, pallor, diaphoresis) and tachycardia seen in this patient.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Ruptured aortic aneurysm (also listed as the single most likely diagnosis, but included here for emphasis): This condition is a medical emergency that requires immediate attention.
- Aortoiliac occlusion: If not promptly treated, this condition can lead to severe ischemia and potentially fatal complications.
- Rare diagnoses
- Lumbar discitis: This condition is an infection of the intervertebral disc and can cause back pain, but it is less likely given the patient's acute presentation and lack of fever.
- Lumbar strain: This condition is a common cause of back pain, but it is unlikely to cause the severe, acute symptoms seen in this patient.
- Pyelonephritis: This condition is an infection of the kidney and can cause back pain, but it is less likely given the patient's lack of fever and urinary symptoms.
- Spinal stenosis: This condition can cause back pain, but it is less likely to cause the acute, severe symptoms seen in this patient.