Sudden Cardiac Arrest Due to Spontaneous Coronary Artery Rupture - A Case Report with a Diagnostic Challenge.

Spontaneous coronary artery rupture (SCAR) is a rare, life-threatening disease, and the diagnosis is often challenging. We herein report a 70-year-old man who suffered sudden cardiac arrest due to SCAR with pericardial fluid. At first, emergent coronary angiography (CAG) failed to detect abnormalities. The emergent operation revealed that the presence of pericardial fluid was caused by bleeding that had spontaneously occurred at the left circumflex artery (LCx). A careful retrospective CAG review showed slight contrast spillage from the distal LCx. SCAR should be suspected in patients with unknown etiology of pericardial effusion, and careful inspection of CAG is necessary.