Abstract
Spontaneous rupture of the thoracic aorta without any apparent aortic pathology is extremely rare. It is a life-threatening condition and almost always requires surgical treatment. We report successful conservative therapy for spontaneous rupture of the aortic arch in an 89-year-old man. The patient presented to a local hospital with severe chest pain and loss of consciousness for a few minutes. An enhanced chest computed tomography showed massive mediastinal hematoma without any specific aortic disease such as aortic dissection or aneurysm. He was transferred to our hospital for possible surgical repair. He was then given a diagnosis of spontaneous rupture of the aortic arch. He was asymptomatic and hemodynamically stable. We decided to treat him conservatively, considering his surgical risk factors such as advanced age, history of ischemic heart disease and severely calcified aortic arch. The blood pressure was strictly controlled according to a standard therapeutic protocol for Stanford type B acute aortic dissection. He was discharged on day 29 and has been followed up showing no recurrence in the past 2 years. Basically we should treat such condition with lifesaving surgery, however, there is an option of non-surgical treatment for selected patients.
