Life-threatening acute aortic syndrome includes aortic dissection, intramural hematoma (IMH) and penetrating atherosclerotic ulcer (PAU). PAU and IMH carry a greater risk for aortic rupture. They most commonly occur in the descending thoracic aorta and are rare in the ascending aorta. Early diagnosis and intervention is crucial. We present the case of a 72-year-old female with a PAU of theascendingaorta complicated byhemopericardium with tamponade as well as IMH, successfully treated after rapid diagnosis and intervention, followed by a brief literature review.