A 19-year-old man died suddenly at home.
His father in the morning found him unconscious and breathing with difficulty.
The night before had gone out.
Emergency services performed resuscitation maneuvers for 25 minutes without results.
There was no pathological history except, according to his father's statement, chest pain in the last 2-3 days.
There was also no history of sudden death in the family.
No significant lesions were found in the external examination of the cadaver.
The patient was a 172 cm-old man with athletic complexion.
Internal examination revealed a tension pericardium with more than 500 ml of blood and pulmonary edema.
Extracardiac findings were irrelevant.
The heart, once fixed in formaldehyde, weighed 407 g and there was an aneurysmal dilatation with hemorrhage of about 4.5 cm in diameter in the proximal ascending aorta, with a continuity solution of 8 mm in the center.
The aortic valve was tricuspid and a transverse and irregular intimal tear of the right sinus of Valsalva was identified at the sinotubular junction of the sinus of Valsalva, in the form of "right apex" of the aneurysm cm.
This tear was the origin of an aortic dissection whose external wall was rotated at the point previously indicated.
Right coronary patency was preserved.
The rest of the coronary arteries, valves and myocardium showed no alterations.
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Microscopically, dissection was observed in the external portion of the media.
The aortic wall showed interruption of the elastic fibers leaving large empty spaces (cystic degeneration of the media).
The dissection plane was covered by periaortic balloon pump and there was large tissue with numerous eosinophils and areas of hemorrhage.
Fibrin and numerous platelets were present at the edge of the rupture of the external wall of the dissection.
These findings were indicative that the dissection had occurred several days earlier (probably in relation to referred chest pain) and that the rupture of the external wall was recent and the cause of cardiac tamponade and cardiac death.
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The chemical-toxicological study determined 0.48 g/l of alcohol in blood and 0.65 g/l in vitreous humor.
