A patient in his 70s presents to the emergency department with a 1-day history of intermittent epigastric abdominal pain that radiates into his back. The patient reports that the pain has been increasing in severity over the past few hours; he vomited after lunch, which led him to seek medical help. The patient has a history of hypertension that is being controlled with metoprolol. He has not experienced fever, diarrhea, or other symptoms associated with his abdominal pain.
His vital signs are normal except for low blood pressure of 91/60 mmHg; his pulse rate (87 bpm) is within the normal range and he has no fever. On physical examination, the patient’s abdomen is tender in the epigastric area with guarding but without mass or rebound. Differential diagnosis include abdominal aortic aneurysm (AAA), sepsis, perforated ulcer, and pancreatitis.
A point-of-care ultrasound is performed to identify potential AAA, which is suspected based on the patient’s low blood pressure, especially considering that he has a history of hypertension (Figure 1).
What does the ultrasound show? What is the next best step in testing and treatment?