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. 2025 Jun 20.
doi: 10.1007/s12024-025-01034-3. Online ahead of print.

A rare case of postmortem diagnosis of penetrating atherosclerotic ulcer rupture in the ascending aorta

Lorenzo Tornese #  1 , Vincenzo Cianci #  2 , Daniela Sapienza  1 , Giovanni Bartoloni  3 , Patrizia Gualniera  1 , Alessio Asmundo  1 , Cristina Mondello  1
Affiliations

A rare case of postmortem diagnosis of penetrating atherosclerotic ulcer rupture in the ascending aorta

Lorenzo Tornese et al. Forensic Sci Med Pathol. .

Abstract

A 74-year-old man underwent both a mitral valve replacement and ascending aorta replacement because of the presence of a critical aneurysm. Postoperatory CT angiography revealed both a periprosthetic hematoma of about 40 mm located at the distal prosthetic graft and a modest effusion at the base of the pericardium. 12 days after the surgery the patient suddenly died. Autopsy showed a cardiac tamponade due to ascending aorta rupture secondary to penetrating atherosclerotic ulcer (PAU). This paper highlights the key gross and microscopic findings of this rare lesion, emphasizing its forensic pathology relevance.

Keywords: Acute aortic syndrome; Cardiac tamponade; Forensic pathology; PAU; Penetrating atherosclerotic ulcer.

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Conflict of interest statement

Declarations. Ethical approval: No authorization from the Ethics Committee was necessary. This is a postmortem case and the data were provided respecting the privacy according to the current Italian Legislation (Italian Authority of Privacy and Data Protection, GDPR nr. 679/2016; 9/2016 and recent law addition number 424/ 19th of July 2018; http://www.garanteprivacy.it ). Competing interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

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