Zusammenfassung
Aneurysmen der thorakalen Aorta führen in der Regel über eine intraperikardiale (Herzbeuteltamponade) oder intrapleurale Ruptur (inneres Verbluten) zum Tod. Außerordentlich selten sind intrapulmonale Rupturen von thorakalen Aortenaneurysmen, die über eine Hämoptyse symptomatisch werden und über eine Blutaspiration letal verlaufen können. Berichtet wird über den Fall eines 40-jährigen Mannes, bei dem nach thorakalen Schmerzen an den Vortagen plötzlich eine Hämoptyse auftrat. Während der diagnostischen Abklärung der Blutungsquelle verstarb er unvorhergesehen. Todesursache war die primäre intrapulmonale, final intrapleurale Ruptur eines thorakalen Aortenaneurysmas an der Stelle einer operativ korrigierten Aortenisthmusstenose.
Abstract
Thoracic aortic aneurysms normally cause death due to either intrapericardial (cardiac tamponade) or intrapleural rupture (internal hemorrhage). There are only very few case reports on sudden unexpected death due to rupture of a thoracic aortic aneurysm into the left lung. Hemoptysis may be the first clinical symptom of a rupture of a thoracic aortic aneurysm into the lungs. In cases of rupture of a thoracic aneurysm into the lungs the cause of death is mostly fatal blood aspiration. This article reports the case of a 40-year-old man who after thoracic pain in the days before death presented in an ear nose and throat clinic (ENT) with suddenly occurring hemoptysis. The patient suddenly collapsed during the diagnostic examination and died despite emergency measures. Cause of death was a primary intrapulmonary and then intrapleural rupture of a thoracic aortic aneurysm at the site of surgical repair of aortic coarctation in childhood.
Literatur
Aebert H, Laas J, Bednarski P et al (1993) High incidence of aneurysm formation following patch plasty repair of coarctation. Eur J Cardiothorac Surg 7:200–204
Ambepitiya SG, Michiue T, Bessho Y et al (2010) An unusual presentation of thoracic aortic aneurysm rupturing into the esophagus: an autopsy case report. Forensic Sci Med Pathol 6:121–126
Borst HG, Klinner W, Senning A (1978) Herz und herznahe Gefäße. Springer, Berlin Heidelberg New York Tokio
Boyd LJ (1924) A study of four thousand reported cases of aneurysm of the thoracic aorta. Am J Med Sci 168:654–667
Chen JH, Ishikawa T, Michiue T, Maeda H (2011) An autopsy case of unexpected sudden death due to rupture of a thoracic aortic aneurysm into the left lung. Leg Med 13:201–204
Clouse WD, Marone LK, Davison JK et al (2003) Late aortic and graft-related events after thoracoabdominal aneurysm repair. J Vasc Surg 37:254–561
Cranley JJ, Herrmann LG, Preuninger RM (1954) Natural history of aneurysms of the aorta. AMA Arch Surg 69:185–197
Derra E, Bircks W (1976) Herzchirurgie. Springer, Berlin Heidelberg New York Tokio
Dhillon JS, Randhawa GK, Straehley CJ, McNamara JJ (1986) Late rupture after dacron wrapping of aortic aneurysms. Circulation 74:I11–I14
Dietel M, Suttorp N, Zeitz M (Hrsg) (2012) Harrisons innere Medizin, 18. Aufl. ABW, Berlin
Heberer G (1966) Aorta und große Arterien. Springer, Berlin Heidelberg New York Tokio, S 617
Piciucchi S, Goodman LR, Earing M et al (2008) Aortic aneurysms: delayed complications of coarctation of the aorta repair using Dacron patch aortoplasty. J Thorac Imaging 23:278–283
Rheuban KS, Gutgesell HP, Carpenter MA et al (1986) Aortic aneurysm after patch angioplasty for aortic isthmic coarctation in childhood. Am J Cardiol 58:178–180
Sun D, Mehta S (2010) Hemoptysis caused by erosion of thoracic aortic aneurysm. CMAJ 182:E186
Tsokos M, Byard RW (2007) Massive, fatal aspiration of blood: not necessarily a result of trauma. Am J Forensic Med Pathol 28:53–54
Ziemer G, Haverich A (2010) Herzchirurgie, 3. Aufl. Springer, Berlin Heidelberg New York Tokio
Interessenkonflikt
Der korrespondierende Autor gibt für sich und seine Koautoren an, dass kein Interessenkonflikt besteht.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Schyma, C., Amberg, R. & Madea, B. Intrapulmonale Ruptur eines Aortenaneurysmas. Rechtsmedizin 23, 196–200 (2013). https://doi.org/10.1007/s00194-013-0887-4
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00194-013-0887-4