特発性大動脈破裂の2例

Spontaneous Rupture of Ascending Aorta：Report of Two Cases

はじめに　特発性大動脈破裂はまれで致死的となりうる，術前診断が困難な疾患である．われわれは術中に特発性大動脈破裂と診断し，良好な結果を得た2例を経験したため報告する．

Spontaneous rupture of the aorta is a rare, lethal condition that is hard to diagnose preoperatively. We report two cases of patients who presented with sudden-onset chest or pharyngeal pain. Contrast-enhanced computed tomography （CT） showed an ulcer-like projection, mediastinal hematoma, and pericardial effusion, but no definitive intimal flap. Emergency surgery was performed with a tentative diagnosis of thrombosed-type aortic dissection. In both cases, there was a localized aortic transmural laceration with a thrombus near the sino-tubular junction on the pulmonary artery side. Based on a focal intimal defect with no or minimal dissection in adjacent area, the diagnosis of spontaneous rupture of the aorta was made. Both patients were successfully treated with replacement of the ascending aorta and had favorable outcomes. When hemopericardium or mediastinal hematoma is present without clear evidence of aortic aneurysm or dissection, spontaneous rupture of the aorta must be considered, as prompt surgical intervention is crucial for survival.