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The correct diagnosis is aortic aneurysm—which the patient acknowledged already being aware of, and for which he said he was under the observation of a vascular surgeon.
The urgent care clinician’s opinion was that the back pain was not related to the aneurysm. The patient was discharged for follow-up, despite the considerable concerns of clinical staff.
However, the patient was insistent that this was a known condition and that he did not want immediate hospitalization.
A post-script: The aneurysm was measured at 6 cm x 7.5 cm, which is definitely sufficient to consider surgery.
Acknowledgment: Case presented by Nahum Kovalski, BSc, MDCM.
Clinical Challenge: June, 2008
Nahum Kovalski, BSc, MDCM
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