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The authors describe a patient with a previously undiagnosed abdominal aortic aneurysm who presented to the emergency department with acute unilateral leg swelling following aneurysm rupture into the vena cava. Abdominal examination raised the suspicion of intra-abdominal pathology which was confirmed with bedside ultrasound, followed by CT aorta. The patient was transferred for urgent repair and made a good recovery. Unilateral leg swelling is a common presentation to frontline clinicians and this case is a reminder that deep vein thrombosis is not the only important cause.

Ruptured abdominal aortic aneurysm presenting as acute unilateral leg swelling - not all swelling below the knee is DVT