Polymorphic presentation of an acute aortic syndrome

We describe a case of a patient with acute aortic syndrome referred to an emergent surgery. Aortic dissection presented with all-in-one imaging and pathologic entities: aortic dissection with intimal flap and true/false lumen, intramural hematoma and penetrating aortic ulcer. Usually, only one of these entities is present in a single patient, but it is possible that one entity evolve into or coexist with another. Extended hemiarch replacement was performed and the patient was discharged in a good condition.