Acute aortic syndrome mimicking intramural hematoma with hemopericardium

We report a case of acute aortic syndrome in a 64-year-old man who presented with chest pain and hypotension. His electrocardiogram and cardiac troponins were normal. Computed tomography showed hemopericardium of 2.4 cm, but no aortic intimal tear. At surgery, the portion of the aorta affected by adventitial hemorrhage was replaced with a Dacron graft. A nonpenetrating ulcerated plaque was also observed. Massive bleeding through the chest drains with hypotension required emergency reoperation in the intensive care unit. The patient was discharged home on postoperative day 11.