Simultaneous presence of an intramural hematoma in the descending thoracic aorta (arrow), changing into a classic aortic dissection in the abdominal aorta (arrowhead) in a 61-year-old woman. An intramural hematoma can always evolve into a classic aortic dissection, as small ruptures and fenestrations (asterisk) within the aortic wall change the hemodynamics in the true and false lumina.