Durmić Tijana, Savić Slobodan, Bogdanović Milenko
Institute of Forensic Medicine "Milovan Milovanović", School of Medicine, University of Belgrade, Deligradska 31a, Belgrade, Serbia.
Forensic Sci Med Pathol. 2019 Sep;15(3):485-487. doi: 10.1007/s12024-019-00114-5. Epub 2019 Apr 26.
A 79-year-old man with a history of arterial hypertension, insulin-dependent diabetes mellitus, renal insufficiency and thoracic endovascular aortic repair (TEVAR) was brought to the emergency department, following an episode of oliguria and urine retention. During chest X-ray he suddenly collapsed and died. Autopsy revealed a large atherosclerotic saccular thoracic aortic aneurysm whose right lateral wall firmly adhered to the right lung. There was more than 2.5 l of blood with fibrin deposits in the right part of the thoracic cavity. The right bronchus contained a cast of blood; blood was also present in the trachea and the distal airways of the right lung. Further dissection revealed that the aneurysm had eroded the tissue surrounding it and made a fistulous canal into the lower lobe of the right lung, causing the lung to fill with fluid blood. The cause of death was hemorrhage from the aortopulmonary fistula caused by pressure necrosis from the thoracic aortic aneurysm.
一名79岁男性，有动脉高血压、胰岛素依赖型糖尿病、肾功能不全及胸主动脉腔内修复术（TEVAR）病史，在出现少尿和尿潴留后被送往急诊科。胸部X线检查时，他突然晕倒并死亡。尸检发现一个巨大的动脉粥样硬化性囊状胸主动脉瘤，其右侧壁与右肺紧密粘连。胸腔右侧有超过2.5升伴有纤维蛋白沉积的血液。右支气管内有血凝块；气管及右肺远端气道也有血液。进一步解剖发现，动脉瘤侵蚀了周围组织，并形成一个通向右肺下叶的瘘管，导致肺内充满血性液体。死亡原因是胸主动脉瘤压迫坏死导致的主肺动脉瘘出血。
