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We report on a 71-year-old woman who underwent successful graft replacement for a ruptured thoracoabdominal aortic aneurysm into the right chest. Computed tomographic scans revealed aneurysmal dilatation of the descending thoracic and thoracoabdominal aorta, and a large right posteroinferior hemothorax with a small left extrapleural hematoma. Digital subtraction angiography showed the aortic aneurysm arising 4 cm distal to the origin of the left subclavian artery and extending to just proximal to the origin of the celiac axis. Emergency graft replacement of the thoracoabdominal aortic aneurysm was performed with a partial cardiopulmonary bypass through the femoral artery and vein. Although the patient required respiratory support with a mechanical ventilator for 48 days, she is presently doing well without limit to activities of daily living 12 months after surgery. We suggest that a combination of computed tomographic scans and aortography is useful in making a correct diagnosis of the extent of the aortic aneurysm and in helping to decide surgical procedures and supportive methods.