A 79 yo M w/ past medical history of HTN and DM presents with a 3 day history of lower back pain. He reports a sycnopal event the morning of his ED visit. He denies chest pain, abdominal pain or palpitations. Initial BP is 130/90 with a HR of 89. Exam is significant for periumbilical tenderness and bilateral lower lumbar paraspinal tenderness. A CT is shown below. What's the diagnosis? (scroll down for answer) 

Answer: Ruptured Abdominal Aortic Aneursym with retroperitoneal hemorrhage

• CT scan shows 6.1 cm ruptured AAA with retroperitoneal hemorrhage
• Initial management - ABCs and stat vascular surgery consult - pt needs OR! 
• Type and cross for blood
• BP controls for MAP 70-80
• Abdominal Aortic Aneurysm
• Defined by aorta > to 3cm
• Classic triad (1/3 of patients)- abdominal/flank pain, pulsatile abdominal mass, and hypotension
• Most commonly: male sex, age > 60, hx of HTN or hx of connective tissue disease

References:

Tintinalli, J. E., Stapczynski, J. S., Ma, O. J., Cline, D., Meckler, G. D., & Yealy, D. M.(2016).Chapter60:Aneurysmal Disease. In Tintinalli's emergency medicine: A comprehensivestudy guide. New York: McGraw-Hill.