An unusual presentation of thoracic aortic aneurysm rupturing into the esophagus: an autopsy case report

Abstract

Ruptured aortic aneurysms often present with sudden death, and have varied signs and symptoms depending on the site of rupture and hemorrhage. We report a case of an aortic aneurysm with an aorto-esophageal fistula, which showed slow gastrointestinal bleeding for days before death. A 79-year-old male was brought to a hospital emergency unit, with a history of melena for about 3 days, and recent hematemesis. He collapsed immediately after endoscopy and died. A forensic autopsy which was performed due to possible medical malpractice demonstrated a large saccular aneurysm of the descending thoracic aorta with a fistula into the esophagus. A significant finding was a lid or valve shaped thrombus covering the aortic orifice of the fistula, which may have partly contributed to slow bleeding, and which may have been dislodged by endoscopy. This case suggests that very careful management of aorto-esophageal fistula is needed in patients with clinical signs of possible thoracic aortic aneurysm with slow hemorrhage.

Huge Thoracic Aortic Aneurysm Presenting with Jaundice: A Case Report

“…11 Other unusual presentations of thoracic aneurysms reported in the literature include erosion of the overlying skin and sternum, rupture into the esophagus, compression and invasion of the pulmonary artery, superior vena cava syndrome, and recurrent laryngeal and phrenic nerve palsy. [12][13][14][15]17,18 The most common causes of jaundice are choledocholithiasis, biliary strictures, carcinoma of the head of the pancreas, pancreatitis, and sclerosing cholangitis. 7 Jaundice has been reported in the literature as a rare presentation of abdominal aortic aneurysm (not TAAs) because of compression and obstruction of biliary ducts.…”

Fístula aortoesofágica

“…Esta causa de muerte súbita puede involucrar quejas con respecto al manejo médico que precede a la muerte en aquellos pacientes que han consultado en días u horas previas al sangrado masivo, razón por la cual los signos clínicos característicos deben ser motivo de alerta en las salas de urgencias [24]. En la tabla 1, se presentan los reportes etioló-gicos de la fae [1].…”

Rupture of an ascending aortic aneurysm as a cause of sudden death

“…Cardiac tamponade is observed when the aneurysm rupture goes into the pericardial sac, as observed in this reported case. Occasionally, the aneurysm rupture passes into the esophagus through an aortoesophageal fistula 10. In a cohort study on acute aortic dissection with 1,079 patients enrolled, Nienaber et al3 found that women were less likely to have aortic dissection (346 cases [32.1%]).…”