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Lethal hemopericardium caused by infection of mitral annular calcification: An autopsy case report

Shigeki Tsuneya1, Taka-Aki Matsuyama2, Maiko Yoshida3

  • 1Department of Legal Medicine, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba 260-8670, Japan; Department of Forensic Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan.

Legal Medicine (Tokyo, Japan)
|March 9, 2024
PubMed

Insights

Mitral annular calcification (MAC) can lead to fatal cardiac tamponade from infection. This forensic case highlights a rare complication of MAC, emphasizing its potential severity.

Area of Science:

  • Forensic Pathology
  • Cardiovascular Pathology
  • Infectious Disease

Background:

  • Mitral annular calcification (MAC) is a degenerative condition associated with cardiovascular disease.
  • MAC is often asymptomatic, posing diagnostic challenges.
  • Infection of MAC is an exceedingly rare but potentially lethal complication.

Observation:

  • An 80-year-old woman presented with cardiopulmonary arrest.
  • Autopsy revealed mitral annular calcification with abscess formation.
  • The abscess had fistulated into the pericardial cavity.

Findings:

  • Gram-positive cocci were identified within the MAC abscess.
  • Massive hemopericardium resulted from the abscess fistulation.
  • The cause of death was cardiac tamponade secondary to infected MAC.

Implications:

  • This case underscores the importance of considering infected MAC in unexplained cardiac events, particularly in forensic investigations.
  • Highlights a rare but fatal consequence of mitral annular calcification.
  • Suggests potential for novel diagnostic or therapeutic approaches in managing infected MAC.
Keywords:
Cardiac tamponadeForensic pathologyHemopericardiumInfectious endocarditisMitral annular calcificationPostmortem computed tomography

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