Ruptured Penetrating Aortic Ulcer With Hemopericardium in a Young Adult: A Case Report.

Penetrating aortic ulcer (PAU) is a rare but highly lethal manifestation of acute aortic syndrome (AAS), most commonly seen in elderly patients with advanced atherosclerosis. Ascending aortic involvement is particularly uncommon but carries a high risk of rupture, hemopericardium, and cardiac tamponade. We present the case of a 33-year-old male with longstanding poorly controlled hypertension who presented to a community hospital with chest pain and syncope. Initial evaluation suggested acute coronary syndrome; however, computed tomography angiography revealed rupture of a penetrating ascending aortic ulcer with intramural hematoma and hemopericardium. The patient underwent prompt helicopter transfer to a tertiary care center and emergent surgical repair. He had an excellent postoperative recovery and remains well on follow-up. This case highlights the importance of maintaining clinical suspicion for acute aortic pathology, the diagnostic utility of computed tomography angiography, and the critical role of rapid systems-based coordination in achieving favorable outcomes in this high-mortality condition.