It is critical to consider vascular etiologies in the differential diagnosis for abdominal-flank pain, including abdominal aortic aneurysm and aortic dissections. Other concerning differentials include appendicitis, mesenteric ischemia, cholecystitis, ectopic pregnancy, gonadal torsion, renal infarction, incarcerated hernia, epididymitis, salpingitis, pyelonephritis, papillary necrosis (sickle cell disease, diabetes, nonsteroidal analgesic abuse, or infection), herpes zoster, drug-seeking behavior, and musculoskeletal strain. Patients receiving outpatient extracorporeal shock wave lithotripsy for urolithiasis may present to the ED with renal colic because the resulting “sludge” is passed in the urine.