A 70-year-old white male presents to the emergency department with sudden onset of severe back pain. The pain is described as severe and constant without alleviating or aggravating symptoms. He has never had pain like this before. He denies chest pain, shortness of breath, or loss of consciousness. He denies any history of an abdominal aortic aneurysm. His past medical history is significant for hypertension, and chronic obstructive pulmonary disease that requires home oxygen therapy. He had bilateral inguinal herniorrhaphy some years ago, but has never had a laparotomy. His vital signs yielded a pulse at 90 bpm and a blood pressure of 110/60 mm Hg. He is appropriately conversant and appears older than his stated age. He was without abdominal tenderness or masses and no bruits were heard; however, his belly was slightly obese and the examination was difficult. He has bilaterally palpable lower extremity pulses.