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Aortic dissection (AD) is a relatively rare but dreadful illness, often accompanied by severe, sharp (or 'tearing') back pain or anterior chest pain, as well as acute hemodynamic compromise. Painless dissection has also been reported in rare cases. Echocardiography has become the most commonly used imaging test for evaluating cardiovascular disease and, thus, plays an important role in aortic disease diagnosis and follow-up.This paper presents the case of a 63-year-old female presenting a chronic cough for more than 30 days, accompanied by chest pain radiating to the left scapula, a history of chronic hypertension, and recent chest x-ray findings of mediastinal mass on the upper left of the aortic knob. Transthoracic echocardiography (TTE) shows a clear image of a dissection flap on the ascending aorta and abdominal aorta, with a false lumen that is larger than the true lumen and filled with intramural thrombus. A transesophageal echocardiography (TOE) examination performed later shows a clear entry tear near the sinuses of Valsalva directly above the ostium of the right coronary artery (RCA). The patient was diagnosed with AD Stanford A de Bakey Type 1. Computed tomography (CT) focusing on the thoracoabdominal aorta and coronary artery was ordered upon suspicion of RCA ostium obstruction by the dissection flap and to further direct the surgical management. However, later on, the patient refused to undergo surgery, opting instead for conservative medical therapy.The diagnosis of AD is challenging. Our case emphasizes the vital role of TTE in diagnosing AD, particularly in patients with atypical symptoms in which the diagnosis of AD might not be considered. Such missed AD diagnoses can lead to precarious outcomes.

In COVID-19 patients, Interleukin-6 (IL-6) will increase, and the production of antigens will be excessive, which will cause excessive inflammation of the tissues, especially the respiratory tract, which causes fibrosis in the lungs and can lead to death.To analyze IL-6 expression of lung tissue in COVID-19 patient severity.The study is an observational analytic design from July to December 2020. COVID-19 patient severity who died was examined for IL-6 expression on lung tissue. The lung tissue sampling uses the core biopsy method.The total number of samples obtained was 38 samples. Characteristics of patients with a mean age of patients were 48 years, male, the most common chief complaint was shortness of breath, mean symptom onset was 5 days, patient length of stay was 10 days, the most common cause of death was a combination of septic shock and ARDS and the most common comorbid diabetes mellitus. There is an increased WBC, neutrophils, platelets, procalcitonin, CRP, BUN, creatinine serum, AST, ALT, and D-dimer. In this study, the average tissue IL-6 expression was 72.63, with the highest frequency of strong positive 47.4%.An increase in IL-6 expression on lung tissue showed the severity of COVID-19 infection.