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Aortopulmonary fistula related death - forensic implications
Tijana Durmić1, Slobodan Savić2, Milenko Bogdanović2
1Institute of Forensic Medicine "Milovan Milovanović", School of Medicine, University of Belgrade, Deligradska 31a, Belgrade, Serbia. tijana.durmic@med.bg.ac.rs.
Forensic Science, Medicine, and Pathology
|April 28, 2019
Summary
A thoracic aortic aneurysm eroded into the right lung, causing fatal hemorrhage. This rare aortopulmonary fistula resulted from pressure necrosis, leading to sudden death in an elderly patient.
Area of Science:
- Cardiovascular Medicine
- Thoracic Surgery
- Pathology
Background:
- A 79-year-old male with hypertension, diabetes, renal insufficiency, and prior thoracic endovascular aortic repair (TEVAR) presented with oliguria and urine retention.
- The patient experienced sudden collapse and death during a chest X-ray examination.
Observation:
- Autopsy revealed a large atherosclerotic saccular thoracic aortic aneurysm with adhesions to the right lung.
- Significant hemorrhage (over 2.5 liters) was found in the thoracic cavity, with blood filling the right bronchus, trachea, and lung airways.
Findings:
- The aneurysm had eroded into the right lower lung lobe, forming an aortopulmonary fistula.
- The cause of death was identified as massive hemorrhage secondary to this fistula, induced by pressure necrosis from the aneurysm.
Implications:
- This case highlights a rare and fatal complication of thoracic aortic aneurysms.
- Emphasizes the importance of vigilant monitoring and management of aortic pathologies, especially in patients with significant comorbidities.
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