We describe the case of a 68-year-old patient who was admitted to the trauma unit with anisocoria after pre-hospital resuscitation upon loss of consciousness. An intracranial bleeding was ruled out. The patient was admitted to the cardiology ward with the initial diagnosis of a syncope due to myocarditis, as myocardial necrosis markers were slightly elevated. The suspicion of an acute aortic dissection (AAD) was raised when the patient developed kidney failure and a progressive aortic regurgitation. He underwent emergency surgery for an acute type A AAD. Renal function recovered completely and, fortunately, the patient was discharged 10 days later.
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