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Previously thought to be extremely rare, renal artery aneurysms are now being found more commonly as incidental findings during the evaluation of refractory hypertension. Symptoms related to the aneurysm are uncommon and rupture occurs infrequently, but with devastating consequences. Factors predisposing to rupture include pregnancy, polyarteritis nodosa, and lack of aneurysmal calcification. Angiography is the study of choice for diagnosing the presence of visceral aneurysm and rupture. We report a case of ruptured renal artery aneurysm that presented with sudden onset of abdominal pain but no significant findings on physical examination. The patient's size precluded the detection of a pulsatile abdominal mass or the ability to obtain an abdominal angiogram. Computed tomography scan with contrast revealed the correct diagnosis, and successful treatment was initiated.

Study objective: To delineate the topics discussed with families during the death notification process and to identify which of these topics are stressful to the physician. Also, the survey served as a needs assessment in designing an educational program for emergency medicine residents in death notification. Design and participants: Forty-five residents and 20 attendings physicians in emergency medicine at the Medical College of Pennsylvania were given an anonymous, self-administered, 47-item questionnaire eeking demographic information and assessing topics discussed during notification, perceived importance to the family of these topics, and the stressfulness of these topics. Results: One hundred percent of the participants responded to the survey. Hospital care, prehospital care, and cause of death were most often discussed with the family, although no topic was discussed 100% of the time by all physicians. Those items that may be perceived as emotionally charged, such as organ donation and autopsy, were rated as more stressful and were less frequently addressed during notification. Conclusion: Factual information is discussed most often, and emotional issues are considered most stressful. Therefore, a program in death notification must address those issues that must be handled during a notification and provide mechanisms for residents to feel comfortable with emotional responses from the family.