Dissection of the pulmonary artery is a rare condition with less than 100 reported cases in the literature. The vast majority of these are found in autopsies [1]. Pulmonary artery dissection can occur in both sexes, with a slight female predominance (male-to-female ratio of 1:1.2). The age of onset ranges from 26 days to 85 years, with incidence peaks observed in the third and sixth decades of life [3]. Inayama et al. [3] reported that in 72% of cases, dissections occur in the main pulmonary trunk. Less frequently affected sites include the intrapulmonary arteries (10%), the combination of the trunk and right main artery (6%), the left main artery (6%), the right main artery alone (4%), and both main arteries along with the trunk (2%). The initiating mechanism of arterial dissection is typically a rupture of the intima extending into the media, allowing blood to infiltrate the medial layer and form a false lumen. It is important to note that the media of the pulmonary artery is significantly thinner than that of the aorta, due to the lower resistance in the pulmonary circulation. As a result, in cases of pulmonary artery dissection, the false lumen is more likely to rupture rather than develop a re-entry site, which is more commonly seen in aortic dissections [4]. The leading cause is congenital heart disease, with persistent ductus arteriosus being the most frequent form. However, other contributing factors can include primary or secondary pulmonary hypertension, vascular inflammation, aorto-pulmonary fistulas, connective tissue disorders, and vessel wall damage resulting from catheterization [1]. Pulmonary artery dissection should be suspected in the presence of certain signs, particularly sudden-onset chest pain, the appearance of a new hilar mass, and the identification on imaging of an intimal flap or both true and false lumens, especially in patients with chronic pulmonary hypertension [3]. In the present case, the patient did not exhibit chest pain; the clinical presentation was limited to persistent dyspnea. Several non-invasive imaging techniques are utilized to identify pulmonary artery dissection in living patients, including transthoracic echocardiography, CT scans, MRI, and pulmonary arteriography [5]. Echocardiography is commonly the initial diagnostic tool due to its widespread availability and cost-effectiveness (Figure 5). However, if echocardiography does not reveal an intimal flap, CT imaging particularly multidetector CT can be employed. CT not only helps detect the dissection but also provides additional details about its extent. When pulmonary embolism is suspected, CT may be preferred as the first diagnostic method [6]. Multidetector CT offers distinct advantages compared to other imaging modalities, such as rapid volumetric coverage and isotropic resolution, enabling multiplanar reconstructions and 3D visualization. These capabilities allow for precise identification of the intimal flap, the dissection’s reach, and any intraluminal thrombi. Furthermore, CT can reveal haemopericardium caused by dissection extending into the pericardium, which may result in acute cardiac tamponade. It also facilitates accurate measurement of aneurysm size and extent, while excluding pulmonary embolism. Modern scanners enhance imaging quality with automated bolus timing [7]. Magnetic Resonance Imaging (MRI) is also considered a reliable option for diagnosing this condition, it typically shows a low-signal intensity image of the intimal flap and can also reveal a hematoma in the pulmonary artery wall, which in the late subacute stage (7 to 30 days) usually appears as high signal intensity on T1- and T2-weighted images, corresponding to an evolution of approximately two weeks [8]. In individuals experiencing chest pain, outcomes following conservative medical treatment have been inconsistent. There are also documented cases of successful surgical management involving graft placement. For patients without symptoms, clinicians face a challenging decision between a watchful waiting strategy—carrying an unpredictable risk of sudden cardiac death and surgical intervention, which, while carrying a known perioperative risk, may offer definitive treatment [9].