INTRODUCTION: Stanford type A aortic dissection is a rare phenomenon with high 
short-term mortality and clinical manifestations that can make differential 
diagnosis a lengthy process requiring several diagnostic examinations.
OBJECTIVES: Based on a case report, the aim is to highlight the importance of 
physical examination in the initial management of these patients and of rapid 
access to a surgical center. A brief review follows on the diagnosis and 
treatment of ascending aortic dissection, and its specific nature in Marfan 
syndrome.
CASE REPORT: A 33-year-old man was admitted to the emergency department of a 
district hospital with chest and back pain associated with vomiting, 20 hours 
after symptom onset. Initial physical examination revealed an aortic systolic 
murmur and musculoskeletal morphological abnormalities compatible with Marfan 
syndrome. Given suspected aortic dissection, a transthoracic echocardiogram was 
immediately performed, which showed an extensive intimal flap originating at the 
sinotubular junction. He was transferred to the cardiothoracic surgery 
department of a referral hospital where he was treated by a Bentall procedure.
CONCLUSION: In this case, careful physical examination during initial assessment 
raised the suspicion that this patient was in a high-risk group for aortic 
dissection, thus avoiding unnecessary and lengthy exams. This diagnosis requires 
emergent surgical treatment, and so direct contact in real time between those 
making in the diagnosis and the surgeon is essential, as well as protocols 
governing immediate access to a surgical center.