Extensive dissecting aneurysm of the ascending aorta

We present the case of a 69-year-old female surviving an extensive dissecting thoracic aortic aneurysm. Due to the initial presentation with angina and epigastric pain the first working diagnosis was acute coronary syndrome. However, on transthoracic and transesophageal echocardiography (TEE), the dissecting aneurysm (type Stanford A) could be detected. Our article stresses the importance of imaging for the rapid and accurate diagnosis of thoracic aortic aneurysms with dissection. In our case, TEE detected the intimal flap separating true and false lumen, and the consecutive hemodynamically relevant aortic valve regurgitation, in addition to the aneurysm extent. The patient underwent surgical repair with aortic arch replacement and recovered without sequelae.