A 55-year-old man presented to the Emergency Department with fatigue and general malaise. He was in atrial fibrillation with rapid ventricular response and in congestive heart failure. He had a right lower quadrant bruit extending to the midline, as well as lower extremity edema, worse in the right leg. In the 1970s he sustained a right buttock gunshot wound; exploratory laparotomy at that time was negative.
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