急性大動脈解離を合併し破裂した胸部大動脈瘤の1例

Ruptured Thoracic Aortic Aneurysm Complicated with Acute Aortic Dissection：Report of a Case

はじめに　胸部大動脈（真性）瘤（thoracic aortic aneurysm：TAA）に急性大動脈解離（acute aortic dissection：AAD）を合併するのはわずか1.6％とまれ1）で，さらにAAD合併時にTAAが破裂するのはきわめてまれ2～7）である．われわれはAADを合併し破裂したTAAの1例を経験したので，切迫破裂例を含んだ文献レビューとともに報告する．

A 68-year-old male with sudden, persistent chest and back pain was referred to our hospital. Contrast-enhanced computed tomography （CT） scans revealed 56 mm thoracic aortic aneurysm （TAA） located from the distal aortic arch to the proximal descending thoracic aorta and Stanford type B acute aortic dissection （AAD） with the patent false lumen distal to the aneurysm. The AAD was not extended within the TAA. Although anti-hypertensive therapy was initiated, the patient unfortunately deceased of sudden cardiopulmonary arrest 6 days later. In the postmortem CT scans, ruptured TAA was diagnosed. Ruptured TAA complicated with AAD was extremely rare, and we report the present case with a literature review.