Aortic Intimo-intimal intussusception described in the late 1800s refers to a circumferential detachment of the intima from the media, forming a loose cylinder inside the aorta. Involves a circular detachment of the intima to form an intimal "cylinder" inside the aorta with a “windsock” appearance. It is believed that the anomalous occurrence of intimal intussusception after aortic dissection is due to the maintained elastic property of the intima in patients who are most often young or without many risk factors and whose cardiac performance is good. Intussusception may be readily identifiable by trans-esophageal echocardiographic examination. In general, patients with this type of tear are critically ill and require emergency surgery, which carries a very high operative mortality of 40%.