A death due to acute aortic dissection
R. H. A. I. Rathnaweera
Faculty of Medicine, Karapitiya, Galle, LK
Acute aortic syndrome (AAS) is a term used to describe a collection of life-threatening aortic disease conditions that have similar presentations, but differ in their demographic, pathological, clinical and other characteristics. The exact number of deaths due to AAS is unknown. However studies suggest that the majority of deaths in AAS are due to acute aortic dissection. A 51-year-old male developed sudden onset chest pain while he was taking a bath in the evening. It was a sharp, tearing type chest pain, which was radiating to the left side of his neck. On admission to hospital his low blood pressure was found to be low. He suffered cardiac arrest a few minutes later and died without regaining consciousness. Post-mortem examination revealed a massive haemopericardium (600 ml). Aortic dissection was identified extending from the aortic root to the lower part of the descending abdominal aorta. The thickest point of the dissection was 1.5 cm. There was an intimal tear inferiorly. The dissection extended through the aortic arch to the descending aorta ending 1 cm above the renal artery branching point. Sections of the aorta showed cystic medial degeneration with prominent pools of mucin. Mild atheroma was seen in some sections. The presence of aortic dissection was confirmed. The cause of death was given as haemopericardium due to ruptured aortic dissection.
Acute aortic dissection may mimic other cardiovascular conditions, especially ischemic cardiac events. Therefore, the clinical suspicion and a comprehensive history-taking are the key for an early diagnosis. Careful dissection of the aorta and its branches is essential when making a post-mortem diagnosis of aortic dissection. Proper histopathology examination of the aorta assisted immensely in confirming the diagnosis.
17 Dec 2020.