CT scan showing multiple PAUs and IMH of the ascending aorta, white arrow points to ascending aorta, red arrow points to PAUs , blue arrow points to IMH

CT scan showing multiple PAUs and IMH of the ascending aorta, white arrow points to ascending aorta, red arrow points to PAUs , blue arrow points to IMH

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The combined pathology of intra-mural haematoma (IMH) and penetrating aortic ulcer (PAU) represents disease progression of the PAU with high risk for further progression to either rupture or pseudo-aneurysm formation, and hence surgical intervention should be offered once diagnosis is made regardless of the presentation. We present a 70-year-old fi...