Case, female, 76 years old. She was admitted to the hospital with chest and back pain for more than 2 months. 2 months ago, she had a sudden onset of severe, persistent, tearing-like pain with profuse sweating. He was admitted to the hospital for further treatment. The CTA suggested an intermural hematoma with multiple penetrating ulcers in the aorta. He had hypertension for 6 years and cataract surgery for 15 years. No abnormalities on admission. Surgery under general anesthesia: implantation of a Cook TBE 40-81 stent to the ascending main, with two stents, Yikin 43-28-180 and 32-26-120, to seal the descending main ulcers. The ulcer disappeared with no endoleak on repeat CT one week after surgery. The natural course of intermural aortic hematoma (IMH) is gradual expansion into a tumor, formation of a coarctation, and rupture, sometimes leading to sudden death by direct rupture. An observation of 66 cases over a 6-year period found that 59% progressed after 30 days and less than 20% survived after 5 years, regardless of treatment. Proximal (type A) hematomas progressed much earlier. In another study comparing 53 cases of type B IMH and 57 cases of type B entrapment, only 4% (2 cases) of IMH required surgery at one year because of progression, while 27% of entrapments required repair. 5-year survival was 97% for IMH and 79% for the entrapment group, and many IMH eventually healed at follow-up. A similar study looked at the prognosis of type A intermural hematoma and aortic coarctation. 16 of 101 patients required emergency surgery for hemodynamic instability and 2 died; of the remaining 85, 6 died and 17 required late surgery, with the clinical predictor being aortic diameter by hematoma thickness. Most of the evolution occurred within 30 days, and late evolution was also observed, with physicians and patients paying attention to the symptoms of hidden pain and discomfort in the chest and back