Aim: To highlight the imaging features and the peculiarities associated with a giant ascending aortic aneurysm in a typical developing world setting. Presentation of Case: A 78-year-old known hypertensive and asthmatic woman of 25 and 10 years duration respectively. She had an untreated degenerative aortic valve lesion and moderate aortic regurgitation. This case study showed the complex interplay of background untreated aortic valve disease, aortic insufficiency, chronic hypertension, chronic airway obstructive disease and ageing in a case of giant aneurysm of the entire ascending aorta. It also emphasizes the role of imaging in diagnosis and follows up of ascending aortic aneurysm particularly where prevention is key to prevent the high mortality associated with Thoracic aneurysymal rupture. Conclusion: Timely institution of appropriate treatment of aortic valve disease, prevention and adequate control of hypertension is key to prevent the development and the grave prognosis of ascending aortic aneurysm, particularly in the developing world where appropriate medical facilities, expertise and treatment are scarce.