Contrast-enhanced CT scan of the ascending aorta. An aortic intramural hematoma of 8 mm in thickness. The ascending and descending aorta shows no dissecting membrane. 

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... 1 A 63-year old male patient was admitted to the intensive care unit of our department, accusing precordial thoracic pain. His cardiovascular risk factors included untreated hypertension, smoking and obesity. His medical history was uneventful. A contrast- enhanced CT scan was carried out in emergency. It showed an enlarged size of the ascending aorta, which was measured at 50 mm in the largest transversal diameter, with a small focal contrast-filled pouch located at the level of the posterior wall. (Fig. 1) No dissection membrane was found. The suspicion of penetrating ulcer of the ascending aorta, associated with an intramural hematoma, arose. A transesophageal echocardiography was performed, in order to better assess the lesions. The examination demonstrated the presence of severe atherosclerosis of the aorta, with a complex, 4 mm thick plaque of the ascending segment, an atheroma of more than 4 mm in thickness of the aortic arch, and a smaller atheroma of the descending thoracic aorta. A localized rupture of an atherosclerotic plaque was also noted, located approximately 2 cm above the sinotubular junction, with passage of the blood in the aortic wall. (Fig. 2) No dissection flap could be individualized. There was no aortic ...