Man With Abdominal Pain

A 51-year-old man presented to the emergency department with 8 hours of diffuse abdominal pain. His history was noteworthy for remote prosthetic aortic and tricuspid valve replacements. He had a temperature of 37.2°C (99.0°F), a pulse rate of 120 beats/min, blood pressure of 93/45 mm Hg, and diffuse abdominal tenderness. Initial laboratory test results showed a WBC count of 13,000/mm3 (reference range 4,000 to 10,000/mm3) and a lactate level of 14.8 mmol/L (normal value <1.9 mmol/L). Bedside ultrasonography of the aorta (Figure 1 and Video E1, available online at http://bit.ly/P50aok) revealed shadowing superior to the renal arteries.

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