Patient Chen, female, 68 years old. She had a history of hypertension and cholecystitis for more than 10 years. Her blood pressure was well controlled by taking antihypertensive medication; her cholecystitis rarely attacked acutely due to a restrained diet. On the day of admission, after eating fatty food (omelette) at dinner, she developed epigastric pain and vomiting, accompanied by back pain, and the abdominal pain was persistently increasing and could not be relieved. Ultrasound of the abdomen at the outpatient clinic revealed mild bile duct dilatation: 1.2 cm in diameter, no clear stone in the gallbladder, and routine blood tests showed 11.1*10^9 leukocytes and 85% neutrophils, and the patient was admitted to the hospital for biliary infection. After hospitalization, the patient complained of unbearable abdominal pain, but blood pressure, heart rate and respiration were stable, cardiopulmonary examination did not reveal any obvious abnormalities. Emergency check of liver function, blood amylase, electrocardiogram, myocardial enzyme spectrum, blood gas analysis and other tests did not find any abnormalities. Half an hour after admission, the patient was treated with analgesia, but the pain symptoms were still not relieved, and suddenly appeared with eyes rolled up, loss of consciousness, purple lips, irregular breathing, electrocardiographic monitoring indicated that the heart rate was >120 beats/min, blood pressure could not be measured, and blood oxygen saturation was about 50%. The patient was immediately resuscitated, and emergency measures were established, such as fast intravenous access for rehydration, vasoactive drugs for pressure boosting, sputum aspiration and high-flow oxygenation by mask. The patient gradually woke up and regained consciousness after resuscitation, but his blood pressure was still unstable under the maintenance of high-dose antihypertensive drugs (alamine and dobutamine), and could only be maintained at about 60/40 mmHg. The chief physician should be consulted urgently. At this time, there was no significant change in the electrocardiogram from the time of admission, and the troponin was negative, which did not support acute massive myocardial infarction, but considered that aortic coarct was more likely. In order to clarify the diagnosis, an emergency chest and abdominal CT revealed an intramural hematoma in the abdominal aorta above the level of the thoracic aorta to the left renal artery as well as a perivascular hematoma in the mediastinum. He was immediately transferred to the intensive care unit (ICU) for further treatment, and his condition is now basically stable. Aortic coarctation, penetrating atherosclerotic ulcer, and intramural hematoma are a group of aortic lesions with similar clinical symptoms, and in recent years it has been proposed to describe this group of pathological changes in the aorta by the term acute aortic syndrome. Each of these lesions has a different pathophysiology, but some patients present with the coexistence of 2 or 3 of them, demonstrating that they are somehow related to each other. They have a similar clinical presentation, with the typical clinical manifestation being thoracic back pain, also known as aortic pain, which presents as sharp, tearing chest and back pain that peaks rapidly after the onset of pain. When the lesion involves the ascending aorta, the pain may radiate to the anterior chest or neck; when the descending aorta is involved, the pain may radiate to the posterior back; when the abdominal aorta is involved, the pain may radiate to the abdomen and low back pain. The disease is mostly seen in middle-aged and elderly people aged 40 to 70 years old, and about 70% of patients have a history of hypertension, which may be due to hypertension that puts the aorta in a long-term stressful state and, over time, causes degenerative changes in the middle elastic tissue. In addition, atherosclerosis, hereditary diseases of the connective tissue, pregnancy, severe trauma and heavy physical labor are also common causes. The onset of the disease is acute and dangerous, and the mortality rate is extremely high, with many patients going into shock or even dying before the diagnosis is clear. The early symptoms of the disease are mainly chest pain, abdominal pain and back pain, and the first symptom of some patients is severe abdominal pain, accompanied by malignant digestive system, vomiting and other symptoms. Therefore, patients with hypertension should actively and effectively control their blood pressure, and seek timely medical attention once severe chest and back or lumbar abdominal pain occurs; when the degree of abdominal pain does not match the abdominal signs, and when the patient has a previous history of hypertension, the abdominal surgeon should make a differential diagnosis between acute abdominal disease and this disease to avoid delay in diagnosis and treatment.