心タンポナーデを伴った胸部大動脈瘤破裂の1例

Cardiac Tamponade due to Rupture of Thoracic Aortic Aneurysm：Report of a Case

はじめに　Stanford A型急性大動脈解離に心タンポナーデを合併することはしばしば認められる所見であり，早急に対応しなければ循環不全をきたし致命的となる．胸部大動脈瘤破裂もまた致命的な疾患であるが，心タンポナーデを合併することはまれである．心タンポナーデの所見から急性大動脈解離が疑われ，造影CTによる精査で弓部大動脈瘤の心囊内穿破と診断し，救命した症例を経験したので報告する．

A 73-year-old woman presented with severe dyspnea. Type A acute aortic dissection with cardiac tamponade was suspected by plain computed tomography （CT）. She was referred to our hospital with cardiogenic shock. In our hospital, contrast-enhanced CT revealed a ruptured aortic arch aneurysm and cardiac tamponade, which is a rare and potentially fatal clinical crisis. The left pulmonary artery was compressed by a hematoma, and there was no aortic dissection. Emergent aortic arch replacement under moderate hypothermia with selective cerebral perfusion was successfully performed. A saccular aneurysm at the lesser curvature of the aortic arch ruptured into the pericardial cavity. Her postoperative course was uneventful, and she was discharged home on the 39th postoperative day.