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Background. Ruptured abdominal aortic aneurysms have a high mortality rate with only 50% of patients surviving to presentation at the emergency department.1 Of those who present, approximately one-third will demonstrate the classically described triad of sudden onset abdominal pain, shock, and pulsatile abdominal mass.1 With advancements in technology, radiographic studies have become an integral component of patient evaluation for rupture. Methods. Review of one case and corresponding radiographic findings.

Results. Hyperattenuated crescent sign observed intraoperatively without direct correlation with rupture.

Conclusions. The hyperattenuated crescent is an important radiographic finding that one should be alerted to in the evaluation of AAA patients. The presence of the sign does not mandate emergent surgery, but care should be taken to optimize the patient’s resuscitation and monitoring in preparation for rupture. Observation of the crescent is not limited to CT imaging and may serve as an important intraoperative finding that may guide operative decision-making.