[Sudden/unexpected death due to spontaneous aortic rupture: two unusual manifestation forms]

Sudden unexpected death from a natural (pathological) cause often occurs under suspicious circumstances suggesting foreign intervention, so that a forensic autopsy is deemed necessary. In adults, a significant share of these deaths is due to spontaneous ruptures of the aorta. In figures, dissections of the ascending aorta and the aortic arch (mostly associated with secondary perforation into the pericardium) account for a large percentage followed by arteriosclerotic aneurysms of the abdominal aorta (with retroperitoneal and sometimes intraperitoneal hemorrhage). The authors report on two fatal aortic ruptures in which the hemorrhage showed an unusual route to spread. In the first case an 80-year-old man with an arteriosclerotic aneurysm of the abdominal aorta died from acute intestinal bleeding via an aortojejunal fistula. In a 42-year-old man, a dissecting hemorrhage in the wall of the aortic arch resulted in the compression of the branching sites of the brachiocephalic trunk, the left common carotid artery and the left subclavian artery, while the volume of blood in the pericardium was rather small (60 ml). On the basis of these examples, the medicolegal aspects of spontaneous aortic ruptures are discussed.