Sudden aortic death-proposal for a comprehensive diagnostic approach in forensic and in clinical pathology practice.

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State: Public
Version: Author's accepted manuscript
Serval ID
serval:BIB_CA6BCAF0E550
Type
Article: article from journal or magazin.
Collection
Publications
Title
Sudden aortic death-proposal for a comprehensive diagnostic approach in forensic and in clinical pathology practice.
Journal
International journal of legal medicine
Author(s)
de Boer H.H., Dedouit F., Chappex N., van der Wal A.C., Michaud K.
ISSN
1437-1596 (Electronic)
ISSN-L
0937-9827
Publication state
Published
Issued date
27/02/2017
Peer-reviewed
Oui
Volume
131
Number
6
Pages
1565-1572
Language
english
Notes
Publication types: Journal Article

Abstract
Aortic rupture or dissection as immediate cause of sudden death is encountered in forensic and clinical autopsy practice. Despite a common denominator of 'sudden aortic death' (SAD), we expect that in both settings the diagnostic workup, being either primarily legal or primarily disease related, differs substantially, which may affect the eventual diagnoses.
We retrospectively reviewed case records of deceased persons who fitted a diagnosis of SAD in the continuous autopsy cohorts in a forensic (Suisse) and a clinical setting (The Netherlands). Clinical characteristics, data from post-mortem imaging, tissue blocks for histological analysis and results of ancillary studies were reviewed for its presence and outcome.
SAD was found in 7.7% in the forensic versus 2.2% in the clinical autopsies. In the forensic setting, autopsy was always combined with post-mortem imaging, showing variable outcome on detection of aortic disruption and/or pericardial bleeding. Histology of aorta was performed in 12/35 cases, mostly in the natural deaths. In the clinical setting, histology of the aorta was available in all cases, but post-mortem imaging in none. In both settings, underlying aortic disease was mostly cystic medial degeneration, atherosclerosis or a combination of both, with occasional rare unexpected diagnosis. Also in both, a genetic cause of aortic dissection was revealed in a minority (three cases).
Sudden aortic death (SAD) is more commonly encountered in a forensic than in a clinical setting. Major differences in the approach of SAD between these settings coincide with similarities in causes of death and underlying diseases. To ensure a correct diagnosis, we recommend that the investigation of SAD includes a study of the medical history, a full autopsy with histology of major organs including aorta, and storage of material for toxicological and genetic testing. Post-mortem radiological examination, useful for documentation and screening purposes, is feasible as non-invasive alternative when autopsy is not possible, but cannot substitute a full autopsy.

Keywords
Aorta, Dissection, Forensic autopsy, Rupture, Sudden death
Pubmed
Web of science
Open Access
Yes
Create date
01/03/2017 15:20
Last modification date
20/08/2019 16:45
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