Autopsy and Case Reports
https://app.periodikos.com.br/journal/autopsy/article/doi/10.4322/acr.2016.044
Autopsy and Case Reports
Article / Autopsy Case Report

Rupture of an ascending aortic aneurysm as a cause of sudden death

Cristielle Peres de Freitas, Carla Andrade Petrini, Ramon Souza Goes Araújo, Luiz Guilherme Cernaglia Aureliano Lima, Patrícia Picciarelli de Lima, Amaro Nunes Duarte-Neto

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Abstract

An 84-year-old female patient was brought to the emergency department in cardiac arrest. Cardiopulmonary resuscitation maneuvers were performed but were unsuccessful. The patient had a past medical history of systemic arterial hypertension with target-organ lesions, including stroke and myocardial infarction. The autopsy was carried out, and the most striking finding was cardiac tamponade due to the rupture of an ascending aortic aneurysm at the site of a complex atheromatous plaque. Rupture is the most serious complication of a thoracic aneurysm and must be considered in the differential diagnosis of sudden death.

Keywords

Aortic Aneurysm, Death, Sudden, Atherosclerosis

References

1. Hiratzka LF, Bakris LG, Beckman JA, et al. 2010 ACCF / AHA / AATS / ACR / ASA / SCA / SCAI / SIR / STS / SVM guidelines for the diagnosis and management of patients with Thoracic Aortic Disease: a report of the American College of Cardiology Foundation / American Heart Association Task Force on Practice Guidelines, American Association for Thoracic Surgery, American College of Radiology, American Stroke Association, Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, Society of Interventional Radiology, Society of Thoracic Surgeons, and the Society for Vascular Medicine. Circulation. 2010;121(13):E266. http://dx.doi.org/10.1161/CIR.0b013e3181d4739e. PMid:20233780.

2. Isselbacher MS. Thoracic and abdominal aortic aneurysms. Circulation. 2005;111(6):816-28. http://dx.doi.org/10.1161/01.CIR.0000154569.08857.7A. PMid:15710776.

3. Nienaber CA, Fattori R, Mehta RH, et al. Gender-related differences in acute aortic dissection. Circulation. 2004;109(24):3014-21. http://dx.doi.org/10.1161/01.CIR.0000130644.78677.2C. PMid:15197151.

4. Tsai TT, Nienaber CA, Eagle KA. Acute aortic syndromes. Circulation. 2005;112(24):3802-13. http://dx.doi.org/10.1161/CIRCULATIONAHA.105.534198. PMid:16344407.

5. Meszaros I, Morocz J, Szlávi J, et al. Epidemiology and clinicopathology of aortic dissection. Chest. 2000;117(5):1271-8. http://dx.doi.org/10.1378/chest.117.5.1271. PMid:10807810.

6. Coady MA, Davies RR, Roberts M, et al. Familial thoracic aortic aneurysms of patterns. Arch Surg. 1999;134:361. http://dx.doi.org/10.1001/archsurg.134.4.361. PMid:10199307.

7. Kennedy JL, Barnard JJ, Prahlow JA. Syphilitic coronary artery ostial stenosis resulting in acute myocardial infarction and death. Cardiology. 2006;105(1):25-9. http://dx.doi.org/10.1159/000088337. PMid:16179782.

8. Cabot RC, Scully RE, Mark EJ, et al. Case records of the Massachusetts General Hospital. Weekly clinicopathological exercises: case 10-1998. A 46-year-old man with chest pain and coronary ostial stenosis. N Engl J Med. 1998;338(13):897-903. http://dx.doi.org/10.1056/NEJM199803263381308. PMid:9518283.

9. Hagan PG, Nienaber CA, Isselbacher IN, et al. The International Registry of Acute Aortic Dissection (IRAD): new insights into an old disease. JAMA. 2000;283(7):897-903. http://dx.doi.org/10.1001/jama.283.7.897. PMid:10685714.

10. Ambepitiya SG, Michiue T, Bessho Y, Kamikodai Y, Ishikawa T, Maeda H. An unusual presentation of thoracic aortic aneurysm rupturing into the esophagus: an autopsy case report. Forensic Sci Med Pathol. 2010;6(2):121-6. http://dx.doi.org/10.1007/s12024-009-9137-1. PMid:20087793.

11. Gilon D, Mehta HR, Oh JK, et al. Characteristics and in-hospital outcomes of patients with cardiac tamponade complicating acute aortic dissection type A. Am J Cardiol. 2009;103(7):1029-31. http://dx.doi.org/10.1016/j.amjcard.2008.12.013. PMid:19327436.

12. Johansson G, Markström U, Swedenborg J. Ruptured thoracic aortic aneurysms: a study of incidence and mortality rates. J Vasc Surg. 1995;21(6):985-8. http://dx.doi.org/10.1016/S0741-5214(95)70227-X. PMid:7776479.

13. Svensjö S, Bengtsson H, Bergqvist D. Thoracic and thoracoabdominal aortic aneurysm and dissection: an investigation based on autopsy. Br J Surg. 1996;83(1):68-71. http://dx.doi.org/10.1002/bjs.1800830122. PMid:8653370.

14. Davies RR, Goldstein LJ, Coady MA, et al. Yearly rupture or dissection for thoracic aortic aneurysms rates: simple prediction based on size. Ann Thorac Surg. 2002;73(1):17-27, discussion 27-8. http://dx.doi.org/10.1016/S0003-4975(01)03236-2. PMid:11834007.

15. Ma TK, Ang LC. Spontaneous rupture of thoracic aorta through an atheromatous plaque: case report and literature review. Am J Forensic Med Pathol. 1996;17(1):38-42. http://dx.doi.org/10.1097/00000433-199603000-00006. PMid:8838468.

16. Shkrum MJ, Silver MD. Delayed rupture of spontaneous tear to the ascending aorta-report of two fatalities. Pathology. 1992;24(3):146-9. http://dx.doi. org/10.3109/00313029209063162. PMid:1437285.

17. Gore I, Seiwert VJ. Dissecting aneurysm of the aorta: pathologic aspects: an analysis of eighty-five fatal cases. Arch Pathol Lab Med. 1952;53(2):121-41. PMid:14884830.

18. Braunstein H. Pathogenesis of dissecting aneurysm. Circulation. 1963;28(6):1071-80. http://dx.doi.org/10.1161/01.CIR.28.6.1071. PMid:14082920.

19. Vázquez Muñiz CA, Delgado Osorio H. Acute dissection of the thoracic aorta: experience at the Puerto Rico Medical Center (1991 through 1995). Bol Asoc Med P R. 1997;89(10-12):161-6. PMid:9580383.

20. Young R, Ostertag H. Incidence, etiology and risk of rupture of aortic aneurysm. An autopsy study. Dtsch Med Wochenschr. 1987;112(33):1253-6. http://dx.doi.org/10.1055/s-2008-1068231. PMid:3608854.

21. Neves FF, Pazin A Jr, Santos JC, Nogueira-Barbosa MH, Elias J Jr, Muglia VF. Acute type A aortic dissection and cardiac tamponade. J Emerg Med. 2011;40(1):62-4. http://dx.doi.org/10.1016/j.jemermed.2008.01.030. PMid:19022611.


Publication date:
09/29/2016

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