Spontaneous rupture of the common carotid artery presenting as a widened mediastinum

Spontaneous rupture of the common carotid artery is an extremely rare disorder. Presentation in an elderly gentleman as a widened mediastinum with cardiac compromise has not been previously reported. Emergency surgical exploration to decompress the airway revealed a 5-mm tear just proximal to the left common carotid artery bifurcation and a large para-oesophageal haematoma. The case is reviewed and the possible causes discussed.