Introduction: The combination of pulmonary embolism (PE) and Stanford type A aortic dissection (AAD) is a rare and complex cardiovascular emergency. The therapeutic management of this combination represents a major challenge. Case report: A 49-year-old hypertensive male smoker presented with sudden migrating chest pain, dyspnoea and haemoptysis. Examination revealed asymmetric brachial pulses. The ECG showed extensive anterior subepicardial ischaemia. Echocardiography revealed septo-apical hypokinesia and pericardial effusion. Angioscan confirmed an AAD with coronary extension and distal left PE. Biological tests showed elevated troponin and D-dimer levels. Conservative medical treatment was instituted with beta-blockers and antihypertensives, with an immediate favourable outcome. Although surgery was indicated, it could not be performed due to a lack of technical facilities. Follow-up at one month was favourable. Conclusion: This case illustrates the possibility of a rare association between PE and AAD extending to the coronary arteries. Although the optimal treatment is surgery, medical management may allow initial stabilisation in the absence of immediate surgical possibility. However, the prognosis remains guarded, requiring prolonged close monitoring.