Cardiac tamponade secondary to rupture of a distal aortic arch aneurysm.

We report the rare rupture of a distal aortic arch aneurysm protruding into the pericardial cavity. A 70-year-old woman who suddenly lost consciousness and was transferred to our hospital by ambulance in profound shock was found in emergency computed tomography and echocardiography to have a dilated distal aortic arch and massive pericardial effusion. Suspecting that a distal aortic arch aneurysm had ruptured, causing cardiac tamponade, we undertook an operation. We found a defect in the aneurysmal wall leading to the pericardium near the main pulmonary artery that was plugged temporarily with an atheromatous mass. We conducted total arch replacement successfully under selective cerebral perfusion and moderate hypothermia.