Our patient presented with right flank that has increased in severity over the recent weeks, but could not pinpoint an accurate timeline. He was reported to have generalized fatigue that continued to worsen over the most recent days. In addition, with his initial fatigue he had some nausea without any vomiting.

On initial evaluation, renal flank plain prompted evaluation of urolithiasis which revealed the previously noted dissection in patient's history. Upon investigation, we noted the active extravasation into a false lumen which appeared to support the right kidney. The pattern persisted into the left common iliac artery.

Normal renovascular anatomy suggests individual support for each renal system thus supporting the unilateral presentation. In addition, general flank pain and hypertension further support the leading cause of an aortic dissection.