We present a case of aortic dissection with shock due to cardiac tamponade in a previously healthy 15-year-old male. The diagnosis was suspected and confirmed by transthoracic echocardiography before transfer to the cardiothoracic unit for successful surgical intervention. Because it is a rare life-threatening condition with a high mortality rate in the pediatric population, a very high index of suspicion is required to reach the clinical diagnosis in a timely manner and institute appropriate surgical management.