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Intramural haematoma and penetrating atherosclerotic ulcer belong to the group of acute aortic syndromes. The combined presentation of both intramural haematoma and a penetrating atherosclerotic ulcer in the ascending aorta is a very rare finding. Here, we present the case of a 72-year-old female, who was admitted to our centre with acute chest and back pain. She was diagnosed with type A intramural haematoma secondary to a penetrating atherosclerotic ulcer of the ascending aorta, and she underwent subsequent emergent surgical management. The diagnosis was confirmed intraoperatively and histopathologically. This case depicts the dynamic pathophysiological development of acute aortic syndromes and the finding that different entities of acute aortic syndromes may evolve or lead to another.

Type A intramural haematoma secondary to penetrating atherosclerotic ulcer of the ascending aorta