Acute aortic dissection of the ascending aorta, Stanford type A, is a form of an acute aortic syndrome that requires immediate surgical management.

Pulmonary artery intramural hematoma is a rare complication of aortic dissection with unknown clinical significance ¹. It has been described in cases where the posterior wall of the aortic root is affected as a result of the extravasation of blood into the common aortopulmonary adventitia ^1-3. It can appear as crescentic or circumferential hyperdense thickening of the pulmonary artery wall and can aid in the diagnosis of aortic dissection in cases where the intimal flap is not readily visible or in cases where pulsation artifacts are present ¹. In this case, the hyperdensities spreading along the course of pulmonary arteries with an obtuse angle toward the pulmonary artery wall indicate the diagnosis. Differential diagnoses include frank mediastinal hemorrhage and extravasation of blood into the pericardial recesses ¹.

An additional incidental finding is a hypoplastic right coronary artery in the setting of left coronary arterial dominance.

The patient was immediately transferred to a cardiothoracic surgery unit and received an aortic prosthesis of the aortic arch and an aortic valve and root replacement.