[Total arch replacement for spontaneous rupture of the thoracic aorta;report of a case].

A 75-year-old man without history of trauma and aortic aneurysm presented with chest discomfort. A computed tomography (CT) revealed massive mediastinal hematoma without intimal flap in the aorta. Under hypothermic circulatory arrest, total arch replacement was performed. A transmural tear was found just distal to the left subclavian artery. Aortic dissection was not found macroscopically. When we encounter massive hematoma in the anterior mediastinum or the left thoracic cavity, spontaneous rupture of the thoracic aorta should be suspected, and emergency operation should be performed via optimal surgical approach.