The clinical presentation of aortic intramural haematoma resembles aortic dissection in many aspects, but the underlying pathophysiology is quite different. Chronic aortic dissection may present as a febrile disease, but is seldom in aortic intramural haematoma. Here we report a case with aortic intramural haematoma with an initial presentation of febrile disease. The patient underwent surgical repair of the diseased aorta successfully and the fever resolved shortly after the operation.