Man With Left Flank Pain

An 81-year-old man with a peripheral vascular disease presented to the emergency department with acute left flank pain for several hours that resolved after oral analgesia. He was hemodynamically stable, and his abdomen and flank were soft and nontender. Laboratory tests included an acutely increased creatinine level of 1.5 mg/dL. A bedside ultrasound demonstrated a hyperechoic left kidney with perinephric fluid and an abdominal aortic aneurysm of 8 cm. Abdominal computed tomography demonstrated an abdominal aortic aneurysm with aorto-left retroaortic renal vein fistula and secondary renal vein infarction with decreased parenchemal enhancement and perinephric fluid

A, Longitudinal ultrasonography of the left kidney showing mild hyperechoic parenchyma with a small amount of perinephric fluid (white arrows). B, Transverse ultrasonography demonstrating a large abdominal aortic aneurysm up to 8 cm

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