Acute atypical type-A thoracic aortic dissection with intramural hematoma: the importance of patient symptoms and the transthoracic echocardiographic examination.

This report demonstrates how transthoracic echocardiography, in conjunction with the sonographer's attention to patient symptomatology, heightened the clinical suspicion of an atypical aortic dissection, leading to further investigation and confirmation. Although initially undiagnosed by computed tomography, a structure suggestive of aortic dissection was subsequently found by transthoracic echocardiography. Transesophageal echocardiography and a second computed tomography examination validated the transthoracic findings. An atypical type A aortic dissection with intramural hematoma was confirmed at operation.