A 65-year-old woman presented to the emergency department with severe abdominal, flank, and back pain that developed 1 day prior. The patient reported that the pain had become progressively worse, and that she could not find relief while sitting or lying down. The patient denied a history of recent trauma. On physical examination, she had hypotension, and a tender abdomen with mass could be felt. The patient had a history of cardiovascular disease, including atherosclerosis, coronary artery disease, and a 40 pack-year history of tobacco use. A CT scan of the abdomen and pelvis demonstrated a large amount of retroperitoneal blood on the right (short red and yellow arrows).
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