A case of successful operative repair of a previously unknown aortic dissection type A after intrapericardial rupture is presented. Under resuscitative measures an inferior pericardiotomy was done, followed by sternotomy to control bleeding under then stabilized circulation. Without detailed diagnostic evaluation, immediate operation with resection of the aneurysm and supracoronary prosthesis interposition was carried out. The diagnostic methods and problems, the differential diagnosis, and comparable cases from the literature are discussed.
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