Emergency management of an acute rupture of a perforated thoracic aortic aneurysm [Notfallmanagement bei akut dissezierendem und gedeckt perforiertem thorakalen Aortenaneurysma]

The emergency medical service was called to a 60-year-old woman with intensive chest pain, signs of shock, dyspnoea, intermittent paraesthesia of the right leg and disturbance of consciousness. With the diagnosis of an acute rupture of an aneurysm of the thoracic aorta, the patient was stabilised with volume, catecholamines, intubation and mechanical ventilation before being rushed to the preinformed department of cardiovascular surgery. The diagnosis was verified by transesophageal echocardiography immediately and the patient underwent surgery 2 h after onset of symptoms. Despite the rupture of the aorta and a short period of cardiac arrest, the patient recovered totally and could be discharged without any residual problems. This case shows that a ruptured thoracic aortic aneurysm can be survived although the overall mortality of this incident is more than 97%.The essentials of a good outcome are: 1. perfectly coordinated rescue operation which means an emergency medical service which includes the rupture of an aortic aneurysm in the differential diagnosis of acute chest pain,2. an early verification of the diagnosis by means of transesophageal echocardiography which should also be carried out by anaesthesiologists due to its importance in the differential diagnosis in haemodynamic unstable patients.