Dissecting the Origins of an Incidental Aortic Pseudoaneurysm: A Case Report and Literature Review.

BACKGROUND: Aortic dissections are life-threatening emergencies characterized by an intimal tear within the aortic wall, resulting in a false lumen. Progressive aortic dilation following repair may predispose patients to aneurysm or pseudoaneurysm formation, increasing the risk of rupture and fatal complications. CASE SUMMARY: A 42-year-old man with prior type A (DeBakey type 1) aortic dissection repair presented with acute chest pain and was found to be in a hypertensive emergency with residual aortic dissection. Despite aggressive blood pressure and heart rate control, imaging demonstrated the development of a 2.5-cm pseudoaneurysm near the right coronary artery origin. DISCUSSION: This rare presentation highlights the importance of surveillance and serial imaging in patients with prior aortic dissection, as delayed vascular complications may occur despite management. TAKE-HOME MESSAGES: Patients with prior aortic dissection repair remain at risk for delayed, life-threatening complications. Individualized management and long-term surveillance are essential for early detection of pseudoaneurysm formation and timely intervention.