5th June 2026

A 67-year-old female with a background of an abdominal aneurysm and hypertension presents with acute onset of chest pain that migrates into her abdomen.

A 67-year-old female with a background of an abdominal aneurysm and hypertension presents with acute onset of chest pain that migrates into her abdomen. She undergoes a TOE in resus and is found to have a dissection from her ascending aorta to her abdominal aorta. She suddenly starts complaining of back pain and becomes haemodynamically unstable with signs of shock. Which area has there likely been a rupture into?

Select the SINGLE most appropriate option from the list below. Select ONE option only.