Limited intimal tear of the ascending aorta in a young patient: a case report.

A 34-year-old man developed sudden retrosternal pain during exercise. Initial CT suggested type A dissection without a visible flap, showing mild pericardial effusion, ascending aortic dilatation, and a subtle bulge. Follow-up CT on day 3 revealed progression, prompting urgent valve-sparing aortic root replacement. Intraoperative findings confirmed a linear intimal fissure. Histology showed cystic medial necrosis. Diagnosis of limited intimal tear (LIT) is challenging due to subtle radiologic signs. Clinicians should suspect this lesion in patients with compatible symptoms despite inconclusive imaging, as prompt surgery is essential to prevent rupture.