This patient is a 55-year-old female who presented with a three day history of severe lower abdominal and back pain. She was seen at an outside hospital the day prior to presentation at our facility. There she underwent a non-contrasted CT scan of her abdomen and pelvis which was non-revealing. Upon presentation to our emergency department she had a systolic blood pressure in the 200’s and immediately had a CT scan which revealed an infrarenal abdominal aortic dissection (see Fig. 1). Bilateral lower extremity pulses were normal as well as a renal function panel (cq1). After adequate blood pressure control and a preoperative arteriogram, the patient was taken for endovascular repair.