A 72-year-old male presented to a local hospital with a 2-day history of significant abdominal and back pain. The attending physician noted that the patient had a 10 cm abdominal aortic aneurysm, and a CT scan of the abdomen was obtained. In addition to the aneurysm, the CT scan showed a horseshoe kidney. The patient had a creatinine level of 2.5. He had bilateral common femoral aneurysms but no history of symptomatic coronary artery disease or stroke. The patient had undergone a presumably curative pneumonectomy for very early bronchogenic carcinoma many years earlier.Following the CT scan, which did not show any evidence of fluid outside the aneurysmal lumen, the patient was emergently referred to Oregon Health Sciences University by the helicopter system and arrived at the medical center about midnight. Examination revealed that the abdomen was tender and the aneurysm was quite painful. The patient described having moderate pain at rest. He did not display any signs of peritoneal irritation. Vital signs were stable. A repeat CT scan was obtained rapidly in the emergency room and again showed no evidence of fluid outside the lumen of the aneurysm. The patient then underwent aortography.