The case of a 66-year-old patient with acute intramural haematoma in descending aorta, receiving anticoagulant treatment with warfarin for chronic atrial fibrillation, is presented. Transoesophageal echocardiography was fundamental in the diagnosis of the intramural haematoma, assessment of the cardioembolic risk of atrial fibrillation and in follow-up the evolution of the intramural haematoma, which facilitated therapeutic management. Although no established recommendation exists on anticoagulation in aortic intramural haematoma, individual risk-benefit assessment of anticoagulation and follow-up with imaging techniques are essential to elect the most appropriate therapeutic management.