Unusual type A aortic dissection.

A 66-year-old woman with hypertension and systemic lupus erythematosus presented with intermittent interscapular and chest pain, progressive dyspnea and presyncope episodes since the previous week. On physical examination she was hemodynamically stable, but jugular venous distension and diminished cardiac sounds were detected. Transthoracic echocardiography showed a pseudoaneurysm of the ascending aorta (Figure 1A, arrow) with an adjacent large mass compressing the right cardiac chambers (Figure 1B, arrow). Thoracic computed tomography confirmed aortic rupture (contrast extravasation suggestive of active rupture; Figure 1C, arrowed circle) associated with a large intramural hematoma (dimensions: 100×87×104 mm) extending inferiorly and compressing the right cardiac chambers (Figures 1D and E, arrow). Urgent surgery was