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Intramural haematoma is an increasingly recognized condition, characterized by an acute haemorrhage into the aortic wall without the creation of a pseudolumen. We present a case that was diagnosed by non-contrast CT scanning, which showed a hitherto undescribed contained rupture into the mediastinum, but no haemothorax. This complicated intramural haematoma was then successfully treated with endoluminal exclusion, which was performed during frank rupture of the thoracic aorta into the left hemithorax which occurred just before the commencement of the endoluminal exclusion.