• Xi He, Eijun Sueyoshi, Shun Nakaji, and Masataka Uetani.
• Department of Radiological Sciences, Graduate School of Biomedical Sciences, Nagasaki University, Sakamoto, Nagasaki, Japan.
• Medicine (Baltimore). 2022 Jan 7; 101 (1): e28472e28472.

RationaleAcute type A aortic dissection and chronic type B aortic dissection (TBAD) occurs simultaneously in rare cases. Although the development of ulcer-like projection (ULP) is associated with an increase in adverse aorta-related events, the false-lumen enlargement caused by the ULP progression is uncommon.Patient ConcernsA 72-year-old female with chronic TBAD was admitted to our unit with back and chest pain. Computed tomography revealed acute type A aortic dissection and a hematoma caused by rupturing of the descending aorta due to chronic TBAD. After endovascular intervention, the false lumen thrombosed and shrunk.DiagnosisAfter 9 months, a developing ULP, which projected into a dilating false lumen, was found. An impending ruptured descending aortic aneurysm was confirmed.InterventionsEmergency Total arch replacement and thoracic endovascular aortic repair (TEVAR) was performed.OutcomesThe procedure was successful. One year later, regular follow-up showed that the false lumen had completely shrunk.LessonsULP can arise and cause progressive dilation of false lumen after TEVAR. Careful and regular computed tomography examinations are required for early diagnosis of false lumen becoming thrombosed after TEVAR. Close follow-up and timely intervention, including TEVAR, should be considered in cases of aortic enlargement due to a newly developed ULP.Copyright © 2022 the Author(s). Published by Wolters Kluwer Health, Inc.

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