Aortic intramural hematoma progressing rapidly to aortic dissection.

A 73-year-old man presented with intermittent chest pain radiating to the back, which had started 12 hours earlier. On the day after emergency consultation, a thoracic scan showed an acute aortic intramural hematoma starting at the sinotubular junction with an ascending aorta diameter of 5.7 cm. One hour after the initial scan, the patient had acute chest pain followed by a loss of consciousness. A second scan was obtained 2 hours after the initial scan and showed a type A aortic dissection that extended from the sinotubular junction to the descending aorta.