MASSIVE SUBPLEURAL HEMORRHAGE ASSOCIATED WITH AORTIC DISSECTION

• Main Authors: Alexandar Alexandrov, Тeodora Kiryakova, Illina Brainova, Аtanas Christov, Metodi Goshev, Dimitar Nikolov, Vesela Ivanova
• Format: Article
• Language: English
• Published: Union of Scientists - Stara Zagora 2019-12-01
• Series: Science & Research
• Subjects: aortic dissection; subpleural haematoma
• Online Access: http://www.sandtr.org/download.php?id=64

Introduction: Aortic dissection is defined as a serious condition with tearing of the inner layer of the large blood vessel branching form the heart with subsequent blood surge through the tear and separation of the inner and middle layers of the aorta. This condition is fatal in cases where the blood-filled channel ruptures through the outside aortic wall. Materials and methods: full forensic autopsy. Case presentation: We present a case of a 58-year-old man with a history of long-term arterial hypertension who sought urgent medical help after having prolong "burning" chest pain for more than 12 hours. The medical team observed the following symptoms: paleness, abundant sweating and decreased blood pressure with a difference between the measured values of the left and right hand of more than 25-30 mm Hg, accelerated pulse - around and above 115 beats per hour. The patient died during the transport in the ambulance despite the intensive resuscitation. Therefore, a forensic autopsy was appointed due to a suspicion of improper medical action by the emergency team. Results: During the autopsy of the cadaver and the separation of the cervical and thoracic complex, a massive sub pleural hematoma with a jelly-like consistency and a weight of about 2.5 - 2.6 kilograms was found on the left part of the chest. From the macroscopic examination of the chest complex of organs, it was evident that there was a pronounced concentric hypertrophy of the left ventricle and the aorta was of normal width for its compartments, with multiple scattered, dense, raised atherosclerotic plaques of the intima. In the area of the aortic arc, there was a ruptured atherosclerotic plaque, from which a detachment of the aortic intima started, reaching the renal arteries - DeBakey III, Stanford B type of aortic dissection. Conclusion: The authors discuss the clinical-morphological and forensic aspects of aortic dissections.