Abdominal aortic aneurysm (AAA) rupture can occur in different ways, such as closed rupture into the retroperitoneum, open rupture into the peritoneal cavity, rupture into surrounding hollow structures, and chronic contained or sealed rupture. Here, we report an unusual case of spontaneous rupture of AAA into a renal cyst that presented with hematuria, abdominal pain and shock, and which was diagnosed with multidetector computed tomography. We also review the literature on unusual patterns of AAA rupture.