Acute onset of lower limb weakness, sphincter dysfunction and sensory disturbance in an older woman

A 62-year-old woman presented 2 days after a fall with acute onset of severe lower back pain, urinary and faecal retention, lower leg weakness and sensory disturbance. The patient had been unwell for 12 months, reporting a 30-kilogram unintentional weight loss and frequent falls. Initial diagnostic computed tomography (CT) of the lumbosacral spine showed a mild L4–L5 posterior disc bulge. Subsequent magnetic resonance imaging showed a normal cauda equina and an incidental lung lesion. It was not until CT staging of her lung cancer (pictured) was performed that an infrarenal abdominal aortic aneurysm (AAA) with an occlusive thrombus was identified. Acute thromboses of AAAs are rare. As of April 2013, only 50 cases had been reported worldwide.1