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11 hrs later - transfer to tertiary centre
There is now more left retroperitoneal stranding and fluid which is displacing the left kidney anteriorly suggesting ongoing slow rupture. In the left posterolateral wall of the lower lobe of the bilobed AAA, there is contrast now extending into the wall in keeping with progression of the acute intramural haematoma (development of an ulcer-like projection (ULP)). This is at the site of the wall thickening and crescent sign on the initial CT.
No active contrast blush is seen outside the aorta. Again, the kidneys appear well perfused.