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Case 16

A middle aged man with sudden left flank pain

This 50 year old man presented to the Emergency Department with a sudden onset of pain in the left flank. The pain had persisted for several hours. He gave a past history of hypertension, and of aortic surgery a few years previously for intermittent claudication.

He was referred for CT scanning due to the suspicion of a ruptured aortic aneurysm. Two sample images are presented from a contrast enhanced study.

What abnormalities are demonstrated? What is the cause of the pain?