Approach to blunt and penetrating abdominal injury Quiz: Ace Your Exams

A 64-year-old man presents to the emergency department for evaluation after falling down three flights of stairs. The patient currently has lower abdominal pain. He has a past medical history of hypertension and diabetes and takes hydrochlorothiazide, metoprolol, and metformin daily. Temperature is 37°C (98.6°F), pulse is 115/min, respirations are 22/min, blood pressure is 148/74 mmHg, and oxygen saturation is 96% on room air. On arrival, the patient can state his name and has normal breathing sounds bilaterally. Glasgow coma scale (GCS) is 15. There is a cervical collar in place, supplemental oxygen is applied, access is established, and intravenous fluids are administered. Secondary survey reveals ecchymosis over the left lower abdomen. Extended focused assessment with sonography in trauma (eFAST) and X-ray of the chest and abdomen are negative. Computed tomography (CT) of the abdomen and pelvis demonstrates a grade 1 splenic laceration without evidence of other traumatic injury. The patient continues to require intravenous fluids despite infusion of multiple liters of lactated ringer. Tertiary survey reveals repeat blood pressure is 100/60 mmHg and repeat abdominal and vascular exam reveals a pulsatile mass over the lower abdomen. The patient has 2+ pulses in the upper extremities, and 1+ pulses in the bilateral lower extremities. Which of the following findings is most likely to be discovered in further imaging studies?