Rupturing 8 cm abdominal aortic aneurysm evidenced by relatively subtle surrounding high attenuation stranding, indicating blood products. Another hint that the expansion of the aneurysm is acute is the mass effect and hydronephrosis on the left kidney. The patient unfortunately suffered cardiac arrest in the ED and was unable to be resuscitated.

The key teaching point in this case is that the findings of acute rupture can be relatively subtle but nonetheless extremely important to detect, as evidenced by this patients rapid clinical decline.