Masquerading Back Pain in a Middle-aged Male

•Abdominal aortic aneurysms (AAAs) are primarily a result of changes in the arterial media and elastic tissues related to coronary atherosclerosis.•The natural history of AAAs is progressive expansion and the best known predictor of rupture is aneurysm size.•Most AAAs are asymptomatic and found during radiologic testing for other reasons.•The role of imaging includes detection of AAA, monitoring of the rate of growth, preoperative planning, and postoperative follow-up.•Screening for AAA in high-risk patients is recommended to decrease the mortality associated with rupture.