Abdominal aortic aneurysm and back pain: a vascular emergency that can present as back pain
Sudden, severe, tearing or ripping pain in the back, abdomen, or flank • A pulsating or throbbing sensation in the abdomen alongside back pain • Back pain with dizziness, fainting, or collapse • These may indicate a ruptured aortic aneurysm — a life-threatening emergency with minutes to act.
What is an abdominal aortic aneurysm?
The aorta is the main artery of the body, running from the heart through the chest and abdomen. An abdominal aortic aneurysm (AAA) is a balloon-like enlargement of the aorta in the abdomen. Small aneurysms are often asymptomatic and managed with monitoring. Large or ruptured aneurysms are immediately life-threatening — rupture carries a mortality rate of 80–90%.
Risk factors
- Male sex — AAA is 6 times more common in men than women
- Age over 65 — the primary age group affected by significant AAA
- Smoking — the most modifiable risk factor; current or past smokers have significantly higher risk
- Hypertension — high blood pressure accelerates aneurysm development
- Family history — a first-degree relative with AAA substantially increases risk
- Atherosclerosis — significant cardiovascular disease is an associated risk factor
All men in England are invited for a free ultrasound scan to screen for AAA at age 65. If you are an older male who smokes or has smoked, or has a family history of AAA, and have not been screened, speak to your GP about arranging a scan. Screening is simple, painless, and could be life-saving.
How AAA can present as back pain
An expanding or leaking AAA can cause a deep, constant, severe pain in the back or flank that may initially be mistaken for musculoskeletal back pain. Unlike mechanical back pain, this pain is typically:
- Not affected by position or movement — it is constant regardless of how you sit, stand, or lie
- Not improving with rest — no posture provides relief
- Severe and out of proportion to the apparent mechanism
- Associated with abdominal tenderness or a pulsatile mass on examination
- May be accompanied by systemic symptoms: sweating, nausea, feeling unwell
Do not assume constant, severe, non-positional back pain is musculoskeletal in an older male with cardiovascular risk factors. The consequences of misidentifying a leaking AAA as back strain are fatal. If in doubt, call 999 or go to A&E immediately.