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Myriad manifestations of infective endocarditis. Aneurysmal disease of the visceral arteries is rare, often found incidentally and carries significant mortality when ruptured. Of these, superior mesenteric artery (SMA) aneurysms represent a small minority of visceral artery aneurysms. This case highlights a man in his late 50s who presented to the emergency department with right upper quadrant and lower back pain. A CT scan revealed an aneurysm in the SMA. Increasing abdominal pain and increasing aneurysmal size with concurrent diagnosis of infective endocarditis suggestive of mycotic aneurysm prompted urgent treatment. The man was treated successfully by endovascular method.