Rupture of dissecting aneurysm: autopsy study of 3 cases

ABSTRACT

Dissecting aneurysm (DA); more appropriately termed dissecting haematoma; is the separation of layers of the vascular wall by a column of blood from the lumen. Dissecting aneurysms of the aorta differ from atherosclerotic and syphilitic aneurysms in that they are not usually associated with marked dilatation of the aorta. DA of the aorta; irrespective of the etiology; if untreated; are associated with a rapidly fatal outcome in 75 per cent to 90 per cent of the patients. Death from DA most often results from rupture. Rupture sites frequently associated with a fatal outcome include the pericardial sac leading to acute haemopericardium; the mediastinum; the left pleural cavity and the retroperitoneum. Autopsy study on three cases of sudden death revealed haemopericardium as a result of rupture of DA of the ascending aorta. One case was seen in a young individual with Marfan's syndrome and two were present in elderly individuals with hypertension. The etiopathogenesis; presentation; outcome and management of this fatal complication is discussed