Vascular, Cardiac Valve, and Metabolic Diseases

  • Reinhard B. Dettmeyer


Potentially fatal diseases include vascular diseases, diseases of the cardiac valves, and metabolic disorders, many of which can only be identified or ruled out histopathologically. Arteriosclerosis is the most common vascular disease, and ruptured aortic aneurysms (rarely, coronary artery aneurysms) are often acutely fatal; on the other hand, inflammation or other vascular disorders (idiopathic cystic medial necrosis, syphilitic aortitis, primary coronary arteritis, coronary arteritis, Takayasu’s arteritis) are rarer. While primary vascular diseases are seen, drug-induced vasculitis is extremely rare. Congenital vascular anomalies such as arteriovenous malformations (Osler–Weber–Rendu syndrome) may remain undetected until death. Only occasionally can preexisting collagenosis be discussed as the cause of death (Marfan syndrome, Ehlers–Danlos syndrome), with the same applying to hemochromatosis. In the case of endocarditis, histopathology can contribute to determining the etiology of the disease and identifying bacterial ulcerative endocarditis, possibly with septic microembolisms.


  1. Adés LC, Waltham RD, Chiodo AA, Baterman JF (1995) Myocardial infarction resulting from coronary artery dissection in an adolescent with Ehlers-Danlos syndrome type IV due to a type III collagen mutation. Br Heart J 74:112–116PubMedPubMedCentralCrossRefGoogle Scholar
  2. Ainsworth RW, Gresham GA (1961) Giant cell aortitis with rupture of the aorta. J Pathol Bacteriol 82:203–205PubMedCrossRefGoogle Scholar
  3. Althoff H (1990) Zur Ätiopathogenese der infantilen Koronarsklerose beim sog. Kawasaki-Syndrom. Pathologe 11:41–47PubMedGoogle Scholar
  4. Amano J, Suzuki A (1991) Coronary artery involvement in Takayasu’s arteritis. J Thorac Cardiovasc Surg 102:554–560PubMedGoogle Scholar
  5. Amine ARC (1997) Neurosurgical complications of heroin addiction: brain abscess and mycotic aneurysm. Surg Neurol 7:385–386Google Scholar
  6. Anagnostopoulos CE, Manakavalan JS, Kittle CF (1972) Aortic dissections and dissecting aneurysms. Am J Cardiol 30:263–273PubMedCrossRefGoogle Scholar
  7. Aru GM, English WP, Netherland D, Heath BJ (1999) Internal thoracic artery rupture in a child with type IV Ehlers-Danlos syndrome. J Thorac Cardiovasc Surg 117:1021–1022PubMedCrossRefGoogle Scholar
  8. Ashrafi AH, Wang J, Stockwell CA, Lloyd D, McAlvin JB, Russo P, Shehata BM (2007) Kawasaki disease: four case reports of cardiopathy with an institutional and literature review. Pediatr Dev Pathol 10:491–499PubMedCrossRefGoogle Scholar
  9. Aufderheide A, Henke B, Parker E (1981) Granulomatous coronary arteritis (Takayasu disease). Arch Pathol Lab Med 105:647–649PubMedGoogle Scholar
  10. August C, Holzhausen HJ (1992) Isolierte Koronararteriitis – Fallbericht und Nomenklaturdiskussion. Pathologe 13:280–285PubMedGoogle Scholar
  11. Banaschak S, Driever F, Nerlich A, Madea B (2002) Aortenruptur bei einem 18-jährigen Mann. Postmortale Diagnose eines Ehlers-Danlos-Syndroms Typ IV. Rechtsmedizin 12:153–158CrossRefGoogle Scholar
  12. Barbesier M, Duncanson ER, Mackey-Bojack SM, Roe SJ, Thomas LC (2013) Sudden death due to spontaneous acute dissection of the left subclavian artery with rupture during postpartum period: a case report. Int J Legal Med 127:453–457PubMedCrossRefGoogle Scholar
  13. Bayer Kristensen I, Østergaard Kristensen B (1994) Sudden death caused by thrombosed coronary artery aneurysm. Two unusual cases of Kawasaki disease. Int J Legal Med 106:277–280CrossRefGoogle Scholar
  14. Bode-Jänisch S, Schmidt A, Günther D, Stuhrmann M, Fieguth A (2012) Aortic dissection aneurysm – histopathological findings. Forensic Sci Int 214:13–17PubMedCrossRefGoogle Scholar
  15. Bratzke H, Wojahn H (1977) Spontane Aortenrupturen aus gerichtsmedizinischer Sicht. Z Rechtsmed 79:159–182PubMedCrossRefGoogle Scholar
  16. Breer S, Amling M, Püschel K, Klein A, Schulz F, Zustin J (2012) Ochronose. Rechtsmedizin 22:49–53CrossRefGoogle Scholar
  17. Brinkmann B (1974) Zur Histomorphologie und Begutachtung zweizeitiger Aortenrupturen. Z Rechtsmed 74:235–243PubMedCrossRefGoogle Scholar
  18. Burman JO (1960) Medial degeneration and its relation to dissecting aneurysm. Int Abstr Surg 110:1–8Google Scholar
  19. Byard RW (2006) Sudden death in Marfan syndrome. In: Tsokos M (ed) Forensic pathology reviews, vol 4. Humana Press, Totowa, pp 93–106CrossRefGoogle Scholar
  20. Byard RW, Keeley FW, Smith CR (1990) Type IV Ehlers-Danlos syndrome presenting as sudden infant death. Am J Clin Pathol 93:579–582PubMedCrossRefGoogle Scholar
  21. Byard RW, Schliebs J, Koszyca BA (2001) Osler-Weber-Rendu syndrome – pathological manifestations and autopsy considerations. J Forensic Sci 46:698–701PubMedGoogle Scholar
  22. Byard RW, Gilbert JD, Langlois NEI (2017) Spontaneous coronary artery dissection. Forensic Sci Med Pathol 13:248–251PubMedCrossRefGoogle Scholar
  23. Cambria RP, Brewster DC, Gertler J, Moncure AC, Gusberg R, Tilson MD, Darling RC, Hammond G, Mergerman J, Abbott WM (1988) Vascular complications associated with spontaneous aortic dissection. J Vasc Surg 7:199–209PubMedCrossRefGoogle Scholar
  24. Canino-Rodriguez A, Cox RA (2008) Giant coronary aneurysms in a young adult patient with Kawasaki disease. P R Health Sci J 27:382–386PubMedGoogle Scholar
  25. Carlson RG, Lillehei CW, Edwards JE (1970) Cystic medial necrosis of the ascending aorta in relation to age and hypertension. Am J Cardiol 25:411–415PubMedCrossRefGoogle Scholar
  26. Cassling RS, Lortz JB, Olson DR, Hubbard TF, McManus BM (1985) Fatal vasculitis (periarteritis nodosa) of the coronary arteries: angiographic ambiguities and absence of aneurysms at autopsy. J Am Coll Cardiol 6:707–714PubMedCrossRefGoogle Scholar
  27. Cohle SD, Lie JT (1988) Inflammatory aneurysm of the abdominal aorta with coronary arteritis. Arch Pathol Lab Med 112:1121–1125PubMedGoogle Scholar
  28. Cohle SD, Titus JL, Espinola A, Hachimczyk A (1982) Sudden unexpected death due to coronary giant cell arteritis. Arch Pathol Lab Med 106:171–172PubMedGoogle Scholar
  29. Collins MH, Schwarze U, Carpentieri DF, Kaplan P, Nathanson K, Meyer JS, Byers PH (1999) Multiple vascular and bowel ruptures in an adolescent male with sporadic Ehlers-Danlos syndrome type IV. Pediatr Dev Pathol 2:86–93PubMedCrossRefGoogle Scholar
  30. Cosgrave GE Jr, Watts JC, Kaump DH (1947) Spontaneous rupture of splenic arterial aneurysms: report of three cases. Am J Clin Pathol 17:372–382CrossRefGoogle Scholar
  31. D’Ovidio C, Sablone S, Carnevale A (2015) Spontaneous coronary artery dissection: case report and literature review. J Forensic Sci 60:801–806PubMedCrossRefGoogle Scholar
  32. Dermengiu S, Ceausu M, Hostiuc S, Curca GC, Dermengiu D, Turculet C (2009) Spontaneous aortic dissection due to cystic medial degeneration. Report of a sudden death and review of the literature. Rom J Leg Med 17:89–96CrossRefGoogle Scholar
  33. Desinan L, Scott CA, Piai I, Mazzolo GM (2010) Sudden death due to spontaneous rupture in splenic artery atypical dissection with features of vasculitis: case report and review of the literature. Forensic Sci Int 200:e1–e5PubMedCrossRefGoogle Scholar
  34. Dettmeyer R, Amberg R, Varchmin-Schultheiß K, Madea B (1998a) Sudden cardiac death due to atypical isolated coronary arteritis? Forensic Sci Int 95:193–200PubMedCrossRefGoogle Scholar
  35. Dettmeyer R, Schmidt P, Madea B (1998b) Two cases of unexpected sudden death due to cystic medianecrosis of the aorta associated with bloodless aortic dissection. Forensic Sci Int 94:161–166PubMedCrossRefGoogle Scholar
  36. Dettmeyer R, Stiel M, Madea B (2006) Chlamydial heat-shock protein 60. A marker for chronic infection with chlamydia pneumoniae in atherosclerosis: investigation of atherosclerotic coronary arteries by immunocytochemistry. Forensic Sci Med Pathol 2:173–178PubMedGoogle Scholar
  37. Dickens P, Khoo US (1993) Sudden death associated with bloodless aortic dissection. Forensic Sci Int 59:149–155PubMedCrossRefGoogle Scholar
  38. Dröber J, Buschmann CT, Blechschmidt C, Martin H, Tsokos M (2010) Kardiale Amyloidose als Ursache eines plötzlichen Todes. Rechtsmedizin 20:278–281CrossRefGoogle Scholar
  39. Eplinius F, Hädrich C (2014) Acute aortic dissection caused by Clostridium septicum aortitis. Forensic Sci Int 244:e38–e41PubMedCrossRefGoogle Scholar
  40. Erbersdobler A, Tsokos M (2006) Sudden, unexpected death resulting from a giant coronary artery aneurysm. Forensic Sci Med Pathol 2:199–201PubMedCrossRefGoogle Scholar
  41. Erdheim J (1929a) Medianecrosis aortae idiopathica. Virchows Arch Pathol Anat Physiol 273:454–479CrossRefGoogle Scholar
  42. Erdheim J (1929b) Medionecrosis aortae indiopathica cystica. Virchows Arch A Pathol Anat Histopathol 276:187–229CrossRefGoogle Scholar
  43. Eriksen UH, Aunsholt NA, Nielsen TT (1992) Enormous right coronary artery aneurysm in a patient with type IV Ehlers-Danlos syndrome. Int J Cardiol 35:259–261PubMedCrossRefGoogle Scholar
  44. Evans RH, Fraser AG (1996) Spontaneous coronary artery rupture and cardiac tamponade in Ehlers-Danlos syndrome type IV. Int J Cardiol 54:283–286PubMedCrossRefGoogle Scholar
  45. Fineschi V, Paglicci Reatelli L, Baroldi G (1999) Coronary artery aneurysms in a young adult: a case of sudden death. A late sequelae of Kawasaki disease? Int J Legal Med 112:120–123PubMedCrossRefGoogle Scholar
  46. Frank S, Johnson A, Ross J Jr (1973) Natural history of valvular aortic stenosis. Br Heart J 35:41–46PubMedPubMedCentralCrossRefGoogle Scholar
  47. Frank MW, Mehlman DJ, Tsai F, Lomasney JW, Joob AW (1999) Syphilitic aortitis. Circulation 100:1582–1583PubMedCrossRefGoogle Scholar
  48. Früchtnicht W, Albrecht R (1998) Aneurysma des Ductus Botalli bei einem 6 Wochen alt gewordenen Säugling. In: 7th spring meeting of the German Society of Forensic Medicine, Bonn, 5–6 June 1998Google Scholar
  49. Fujita M, Abe A, Itoh T, Saitoh K, Noguchi M, Sano K, Fujiioka Y, Nagashima K (1992) Nonarthritic rheumatoid valvulitis with coronary arteritis causing myocardial infarction. Virchows Arch A Pathol Anat Histopathol 420:109–112PubMedCrossRefGoogle Scholar
  50. Galtés I, Borondo JC, Cos M, Subirana M, Martín C, Castellà J, Medallo J (2012) Traumatic bilateral vertebral artery dissection. Forensic Sci Int 214:e12–e15PubMedCrossRefGoogle Scholar
  51. Gertz MA (1992) Familial amyloidosis and the heart. Arch Intern Med 166:1805–1813Google Scholar
  52. Gilchrist ER, Duflou JA (2005) Incidental myocardial infarction in Ehlers-Danlos syndrome type IV? J Forensic Sci 50:461–464PubMedCrossRefGoogle Scholar
  53. Glenewinkel F, Schmidt P, Arnold G, Henßge C (1996) Plötzlicher Tod beim subtotalen Verschluß des rechten Koronarostiums durch eine Mesaortitis luica. Rechtsmedizin 6:49–52Google Scholar
  54. Gore I (1953) Dissecting aneurysm of the aorta in persons under forty years of age. Arch Pathol 5:1–3Google Scholar
  55. Gormsen H (1984) Postmortem diagnosis of syphilitic aortitis, including serological verification on postmortem blood. Forensic Sci Int 24:51–56PubMedCrossRefGoogle Scholar
  56. Gravanis MB (2000) Giant cell arteritis and Takayasu aortitis: morphologic, pathogenic and etiologic factors. Int J Cardiol 75(Suppl):S21–S33PubMedCrossRefGoogle Scholar
  57. Gsell O (1928) Wandnekrosen der Aorta als selbständige Erkrankung und ihre Beziehung zur Spontanruptur. Virchows Arch A Pathol Anat Histopathol 276:1–36Google Scholar
  58. Guitierrez PS, Correia de Almeida I, Nader HB, de Lourdes HM, Stolf N, Dietrich CP (1991) Decrease in sulphated glycosaminoglycans in aortic dissection – possible role in the pathogenesis. Cardiovasc Res 25:742–748CrossRefGoogle Scholar
  59. Hagemeier L, Unkrig S, Madea B (2009) Dissezierendes Milzarterienaneurysma bei fibromuskulärer Dysplasie. Rechtsmedizin 19:21–24CrossRefGoogle Scholar
  60. Halpern M, Citron BP (1971) Necrotizing angiitis associated with drug abuse. Am J Roentgenol 111:663–671CrossRefGoogle Scholar
  61. Hassan W, Al-Sergani MW et al (2005) Amyloid heart disease. New frontiers and insights in pathophysiology, diagnosis, and management. Tex Heart Inst J 32:178–184PubMedPubMedCentralGoogle Scholar
  62. Hirani R, Koszyca B, Byard RW (2008) Marfan syndrome and sudden death within a family – aetiologic, molecular and diagnostic issues at autopsy. J Forensic Legal Med 15:205–209CrossRefGoogle Scholar
  63. Hirst AE, Gore J (1976) Is cystic medianecrosis the cause of dissecting aorta aneurysms? Circulation 53:915–916PubMedCrossRefGoogle Scholar
  64. Hoffmann B, Mayatepek E (2009) Fabry disease – often seen, rarely diagnosed. Dtsch Arztebl Int 106:440–447PubMedPubMedCentralGoogle Scholar
  65. Horton BT, Magath TB, Browne GE (1932) An undescribed form of arteritis of the temporal vessels. Proc Staff Meet Mayo Clin 7:700–701Google Scholar
  66. Hugar BS, Praveen S, Kainoor SK, Shetty ARS (2014) Sudden death in Marfan Syndrome. J Forensic Sci 59:1126–1128PubMedCrossRefGoogle Scholar
  67. Hushang M, Payan MD, Enid F, Gilbert MD (1984) Granulomatous coronary arteritis. Arch Pathol Lab Med 108:136–137Google Scholar
  68. Inokuchi G, Hayakawa M, Kishimoto T, Makino Y, Iwase H (2014) A suspected case of coronary periarteritis due to IgG4-related disease as a cause of ischemic heart disease. Forensic Sci Med Pathol 10:103–108PubMedCrossRefGoogle Scholar
  69. Ishikawa T, Pollak S, Pflugradt R, Bohnert M, Große Perdekamp M, Thierauf A, Maeda H (2010) Pulmonary arteriovenous malformation causing sudden death due to spontaneous hemothorax. Int J Legal Med 124:459–465PubMedCrossRefGoogle Scholar
  70. Johnston SL, Lock RJ, Gompels MM (2002) Takayasu arteritis: a review. J Clin Pathol 55:481–486PubMedPubMedCentralCrossRefGoogle Scholar
  71. Judge DP, Dietz HC (2005) Marfan’s syndrome. Lancet 366:1965–1976PubMedPubMedCentralCrossRefGoogle Scholar
  72. Jung H, Lostun A, Matei DB (2013) Coronary artery dissection as cause of sudden death. Rom J Leg Med 21:85–90CrossRefGoogle Scholar
  73. Jungmann L, Bohnert M, Schmidt U, Pollak S (2010) Plötzlicher Tod durch spontane Aortenruptur: zwei ungewöhnliche Manifestationensformen. Arch Kriminol 226:55–65PubMedGoogle Scholar
  74. Kaiser C, Schnabel A, Berkefeld J, Bratzke H (2008) Traumatic rupture of the intracranial vertebral artery due to rotational acceleration. Forensic Sci Int 182:e15–e17PubMedCrossRefGoogle Scholar
  75. Kajihara H, Tachiyama Y, Hirose T, Takata A, Saito K, Murai T, Yasui W (2013) Eosinophilic coronary periarteritis (vasospastic angina and sudden death), a new type of coronary arteritis: report of seven autopsy cases and a review of the literature. Virchows Arch 462:239–248PubMedCrossRefGoogle Scholar
  76. Karayel F, Ozaslan A, Turan AA, Pakis I, Ketenc C, Eroglu AG (2006) Sudden death in infancy due to bicuspid aortic valve. J Forensic Sci 51:1147–1150PubMedCrossRefGoogle Scholar
  77. Karger B, Fechner G (2006) Sudden death due to giant cell coronary arteritis. Int J Legal Med 120:377–379PubMedCrossRefGoogle Scholar
  78. Kawasaki T, Kosaki F, Okawa S, Shigematsu I, Yanagawa H (1974) A new infantile acute febrile mucocutaneous lymph node syndrome (MLNS) prevailing in Japan. Pediatrics 54:271–276PubMedGoogle Scholar
  79. Kieninger B, Eriksson M, Kandolf R, Schnabel PA, Schönland S, Kristen AV, Hegenbart U, Lohse P, Röcken C (2010) Amyloid in endomyocardial biopsies. Virchows Arch 456:523–532PubMedCrossRefGoogle Scholar
  80. Kimmelstiel P, Gilmour MT, Hodges HH (1952) Degeneration of elastic fibers in granulomatous giant cell arteritis (temporal arteritis). Arch Pathol 54:157–168Google Scholar
  81. King J, Richards M, Tress B (1978) Cerebral arteritis associated with heroin abuse. Med J Aust 2:444–445PubMedGoogle Scholar
  82. Kinnane J, Priebe C, Caty M, Kuppermann N (1995) Perforation of the colon in an adolescent girl. Pediatr Emerg Care 11:230–232PubMedCrossRefGoogle Scholar
  83. Klintschar M, Stiller D (2004) Sudden cardiac death in hereditary hemochromatosis: an underestimated cause of death? Int J Legal Med 118:174–177PubMedCrossRefGoogle Scholar
  84. Klintschar M, Bilkenroth U, Arslan-Kirchner M, Schmidke J, Stiller D (2009) Marfan syndrome: clinical consequences resulting from a medicolegal autopsy of a case of sudden death due to aortic rupture. Int J Legal Med 123:55–58PubMedCrossRefGoogle Scholar
  85. Kodikara S, Sivasubramanium M (2009) Bilateral pulmonary artery aneurysms. Legal Med 11:S496–S497PubMedCrossRefGoogle Scholar
  86. Kraemer BF, Seizer P, Geisler T, Klingel K, Kandolf R, Lindemann S, Gawaz M (2009) Persistent troponin elevation in a patient with cardiac amyloidosis. Clin Cardiol 32:E39–E42PubMedCrossRefGoogle Scholar
  87. Kristoffersen S, Vetti N, Morild I (2012) Traumatic dissection of the vertebral artery in a toddler following a short fall. Forensic Sci Int 221:e34–e38PubMedCrossRefGoogle Scholar
  88. Krompecher T, Saraga EP, Gardiol G (1984) Plötzlicher Tod aus natürlicher Ursache: Isolierter Befall eines Herzkranzgefäßes durch eine Arteriitis vom Typ Takayasu. Beitr Gerichtl Med 42:155–163PubMedGoogle Scholar
  89. Kumar P, Velissaris T, Sheppard MN, Pepper JR (2002) Giant cell arteritis confined to intramural coronary arteries. Unforeseen hazards myocardial protection. Cardiovasc Surg 43:647–649Google Scholar
  90. Landing BH, Larson EJ (1987) Pathological features of Kawasaki disease (mucocutaneous lymph node syndrome). Am J Cardiovasc Pathol 1:218–229PubMedGoogle Scholar
  91. Lau G (2002) Fatal pulmonary haemorrhage from a perforated and possibly iatrogenic thoracic aortic aneurysm. Forensic Sci Int 126:167–170PubMedCrossRefGoogle Scholar
  92. Leu HJ (1993) Spontane dissezierende Aneurysmen von Arterien des muskulären Bautyps infolge mukoider Mediadegeneration (mediolytische Arteriopathie). Pathologe 14:325–329PubMedGoogle Scholar
  93. Leu AJ, Leu HJ (1988) Eigenartige bandförmige Degeneration der Aortenmedia als Ursache multipler Aneurysmata der Aorta thoracalis und abdominalis. Pathologe 9:366–369PubMedGoogle Scholar
  94. Li Y, Li L, Mu HS, Fan SL, He FG, Wang ZY (2015) Aortic dissection and sudden unexpected deaths: a retrospective study of 31 forensic autopsy cases. J Forensic Sci 60:1206–1211PubMedCrossRefGoogle Scholar
  95. Lie JT (1987) Coronary vasculitis. Arch Pathol Lab Med 111:224–233PubMedGoogle Scholar
  96. Lie JT (1992) Segmental mediolytic arteritis. Not an arteritis but a variant of arterial fibromuscular dysplasia. Arch Pathol Lab Med 116:238–241PubMedGoogle Scholar
  97. Lupi-Herrera E, Sanchez-Torres G, Marcushamer J, Mispireta J, Horwitz S, Vela JE (1977) Takayasu’s arteritis: clinical study of 107 cases. Am Heart J 93:94–103PubMedCrossRefGoogle Scholar
  98. Lynch MJ, Woodford NWF, Dodd MJ (2008) Sudden death due to aortic rupture complicating undiagnosed coarctation of the aorta in a teenager – a case report and review of the literature. J Forensic Legal Med 15:443–446CrossRefGoogle Scholar
  99. Maeso Madronero JL, Aretz S, Theis U, Morgenroth K, Bergbauer M (2000) Aortenruptur bei idiopathischer Medianekrose Gsell-Erdheim. Dtsch Med Wschr 125:1195–1198PubMedCrossRefGoogle Scholar
  100. Magarey FR (1950) Aneurysm in giant-cell aortitis. Dissecting aneurysm due to giant-cell aortitis. J Pathol Bact 62:445–447CrossRefGoogle Scholar
  101. Makino Y, Inokuchi G, Yokota H, Hayakawa M, Yajima D, Motomura A, Chiba F, Torimitsu S, Nakatani Y, Iwase H (2015) Sudden death due to coronary artery dissection associated with fibromuscular dysplasia revealed by postmortem selective computed tomography coronary angiography: a case report. Forensic Sci Int 253:e10–e15PubMedCrossRefGoogle Scholar
  102. Martin JF, Kittas C, Triger DR (1980) Giant cell arteritis of coronary arteries causing myocardial infarction. Br Heart J 43:487–489PubMedPubMedCentralCrossRefGoogle Scholar
  103. McConnell ME, Hannon DW, Steed RD, Gilliland MG (1998) Fatal obliterative coronary vasculitis in Kawasaki disease. J Pediatr 133:259–261PubMedCrossRefGoogle Scholar
  104. Melsen F (1973) Spontaneous rupture of the aorta in the Marfan’s syndrome. Z Rechtsmed 73:53–60PubMedCrossRefGoogle Scholar
  105. Merlini G (2003) Molecular mechanism of amyloidosis. N Engl J Med 349:583–596PubMedCrossRefGoogle Scholar
  106. Merrell SW, Gloviczki P (1992) Splenic artery dissection: a case report and review of the literature. J Vasc Surg 15:221–225PubMedCrossRefGoogle Scholar
  107. Missliwetz J, Reiter C, Winter RE (1981) Differential diagnosis of Kawasaki syndrome. Beitr Gerichtl Med 39:307–316PubMedGoogle Scholar
  108. Mitchinson MJ, Wight DJD, Arno J (1984) Chronic coronary periarteritis in two patients with coronary periaortitis. J Clin Pathol 37:32–36PubMedPubMedCentralCrossRefGoogle Scholar
  109. Murai T, Kuroda N, Shinozuka T, Kurihara K, Yanagida J, Watanabe H, Saito K, Maurai N, Imai M (1989) Coronary aneurysms in a young adult: report of a case suspected of Kawasaki’s disease. Med Sci Law 29:59–63PubMedCrossRefGoogle Scholar
  110. Morcos M, Alfiano M, Gompel A, Regnard J (2006) Life-threatening endometriosis-related hemopneumothorax. Ann Thorac Surg 82:726–729PubMedCrossRefGoogle Scholar
  111. Morgenthal S, Bayer R, Schneider E, Zachäus M, Röcken C, Dreßler J, Ondruschka B (2016) Nodular pulmonary amyloidosis with spontaneous fatal blood aspiration. Forensic Sci Int 262:e1–e4PubMedCrossRefGoogle Scholar
  112. Naeve W, Brinkmann B (1971) Zur Begutachtung der Medianecrosis aortae idiopathica als Todesursache beim Sport. Z Rechtsmed 68:101–104PubMedCrossRefGoogle Scholar
  113. Nakajima K, Takeichi S, Nakajima Y, Fujita MQ (2010) Pokkuri death syndrome: sudden cardiac death cases without coronary atherosclerosis in South Asian young males. Forensic Sci Int 207(1–3):6–13PubMedGoogle Scholar
  114. Nashima Y, Kurozumi T, Sueishi K, Tanaka K (1990) Dissecting aneurysms: a clinicopathologic and histopathologic study of 111 autopsied cases. Hum Pathol 21:291–296CrossRefGoogle Scholar
  115. Nelson DA, Ashley PF (1965) Rupture of the aorta during closed-chest cardiac massage. JAMA 193:681–683PubMedCrossRefGoogle Scholar
  116. Nerlich AG, Stöss H, Lehmann H, Krieg T, Müller PK (1994) Pathomorphological and biochemical alterations in Ehlers-Danlos-syndrome type IV. Pathol Res Pract 190:697–706PubMedCrossRefGoogle Scholar
  117. Niederau C, Fischer R, Sonnenberg A, Stremmel W, Trampisch HJ, Strohmeyer G (1985) Survival and causes of death in cirrhotic and noncirrhotic patients with primary hemochromatosis. N Engl J Med 313:1256–1262PubMedCrossRefGoogle Scholar
  118. Norita K, de Noronha SV, Sheppard MN (2012) Sudden cardiac death caused by coronary vasculitis. Virchows Arch 460:309–318PubMedCrossRefGoogle Scholar
  119. Noth I, Strek ME, Leff AR (2003) Churg-Strauss-syndrome. Lancet 361:587–594PubMedCrossRefGoogle Scholar
  120. Ortmann C, Wüllenweber J, Brinkmann B, Fracasso T (2010) Fatal mycotic aneurysm caused by Pseudallescheria boydii after near drowning. Int J Legal Med 124:243–247PubMedCrossRefGoogle Scholar
  121. Owen SM, Durst RD (1984) Ehlers-Danlos syndrome simulating child abuse. Arch Dermatol 120:97–101PubMedCrossRefGoogle Scholar
  122. Palmiere C, Burkhardt S, Staub C, Hallenbarter M, Pizzolato G, Dettmeyer R, La Harpe R (2004) Thoracic aortic dissection associated with cocaine abuse. Forensic Sci Int 141:137–142CrossRefPubMedGoogle Scholar
  123. Passen EL, Rodriguez R, Neumann A, Tan CD, Parillo JE (1996) Cardiac hemochromatosis. Circulation 94:2302PubMedCrossRefGoogle Scholar
  124. Patterson RH, Burns WA, Jannotta FS (1974) Complications of external cardiac resuscitation: a retrospective review and survey of the literature. Med Ann Dist Columbia 43:389–394PubMedGoogle Scholar
  125. Paul RA, Helle MJ, Tarssanen LT (1990) Sudden death as sole symptom of coronary arteritis. Ann Med 22:161–162PubMedCrossRefGoogle Scholar
  126. Pereira MC, Filho AA, Lastoria S (1981) Inflammatory aneurysm of the abdominal aorta with coronary arteritis. Arch Pathol Lab Med 105:678–679PubMedGoogle Scholar
  127. Pery C, Frenzel H, Schindler P (1983) Aortenruptur als seltene Komplikation der Riesenzell-Arteriitis. Pathologe 4:204–211Google Scholar
  128. Pourhassan S, Grotemeyer D, Klar V, Sandmann W (2007) Klippel-Trenaunay syndrome associated with multiple visceral arteries aneurysm. Vasa 36:124–129PubMedCrossRefGoogle Scholar
  129. Prahlow JA, Wagner SA (2005) Death due to Ehlers-Danlos syndrome type IV. Am J Forensic Med Pathol 26:78–82PubMedCrossRefGoogle Scholar
  130. Reis ED, Martinet OD, Mosimann F (1998) Spontaneous rupture of the oesophagus in an adolescent with type IV Ehlers-Danlos syndrome. Eur J Surg 164:313–316PubMedCrossRefGoogle Scholar
  131. Rippberger T, Tröger HD, Schmidtke J (2009) The genetic message of sudden unexpected death due to thoracic aortic dissection. Forensic Sci Int 187:1–5CrossRefGoogle Scholar
  132. Risse M, Weiler G (1987) Spontanes Aneurysma dissecans einer Kranzschlagader als seltene Ursache eines postpartalen Todes der Kindesmutter. Z Rechtsmed 99:143–150PubMedGoogle Scholar
  133. Risse M, Lasczkowski G, Dettmeyer R, Verhoff MA (2010) Spontane Aortenruptur ohne Dissektion. Plötzlicher Tod während der Schwangerschaft. Rechtsmedizin 20:34–35CrossRefGoogle Scholar
  134. Roberts DL, Pope FM, Nicholls AC, Narcisi P (1984) Ehlers-Danlos syndrome type IV mimicking non-accidental injury in a child. Br J Dermatol 111:341–345PubMedCrossRefGoogle Scholar
  135. Robertson EN, Hambly BD, Jeremy RW (2016) Thoracic aortic dissection and heritability: forensic implications. Forensic Sci Med Pathol 12:366–368PubMedCrossRefGoogle Scholar
  136. Röcken C (2008) Pathologie der Amyloidose. Nephrologe 3:275–284CrossRefGoogle Scholar
  137. Röcken C (2009) Update immunhistologischer Klassifikation der Amyloidose. Pathologe 30(suppl 2):121–123PubMedCrossRefGoogle Scholar
  138. Rosen N, Gaton E (1972) Takayasu’s arteritis of coronary arteries. Arch Pathol 94:225–229PubMedGoogle Scholar
  139. Rottino A (1939) Medial degeneration of the aorta. A study of two hundred and ten routine autopsy specimens by a serial block method. Arch Pathol 28:377–385Google Scholar
  140. Rowley AH, Shulman ST (2010) Pathogenesis and management of Kawasaki disease. Expert Rev Anti-Infect Ther 8:197–203PubMedPubMedCentralCrossRefGoogle Scholar
  141. Rozin L, Koehler SA, Shakir A, Ladham S, Wecht CH (2003) Kawasaki disease: a review of pathologic features of stage IV disease and two cases of sudden death among asymptomatic young adults. Am J Forensic Med Pathol 24:45–50PubMedGoogle Scholar
  142. Saint-Martin P, Rogers C, Carpenter E, Fishbein MC, Lau S, Sathyavagiswaran L (2009) Subaortic pseudoaneurysm of the left ventricle complicating staphylococcal endocarditis. J Forensic Sci 54:930–932PubMedCrossRefGoogle Scholar
  143. Salvarani C, Cantini F, Boiardi L, Hunder GG (2002) Polymyalgia rheumatica and giant cell arteritis. N Engl J Med 347:261–271PubMedCrossRefGoogle Scholar
  144. Sariola H, Viljanen T, Luosto R (1986) Histological pattern and changes in extracellular matrix in aortic dissections. J Clin Pathol 39:1074–1081PubMedPubMedCentralCrossRefGoogle Scholar
  145. Saruk M, Eisenstein R (1977) Aortic lesion in Marfan syndrome. The ultrastructure of cystic medial degeneration. Arch Pathol Lab Med 101:74–77PubMedGoogle Scholar
  146. Saukko P, Knight B (2004) Knight’s forensic pathology, 3rd edn. Arnold, London, pp 492–526Google Scholar
  147. Saulsbury FT, Hayden GF (1985) Skin conditions simulating child abuse. Pediatr Emerg Care 1:147–150PubMedCrossRefGoogle Scholar
  148. Schäfer H, Püschel K (1996) Proximale Aortitis als Ursache eines unerwarteten plötzlichen Herztodes bei einem Kleinkind. Pathologe 17:324CrossRefGoogle Scholar
  149. Scharfman WB, Wallach JB, Angrist A (1950) Myocardial infarction due to syphilitic coronary ostial stenosis. Am Heart J 40:603–613PubMedCrossRefGoogle Scholar
  150. Schlatman TJM, Becker AE (1977) Pathogenesis of dissecting aneurysma of aorta. Comparative histopathologic study of significance of medial changes. Am J Cardiol 39:21–26CrossRefGoogle Scholar
  151. Schmidt P, Madea B, Oehmichen M, Gerling I (1996) Plötzlicher Tod bei idiopathischer cystischer Medianekrose – Analyse von 6 Fällen unter Berücksichtigung arztrechtlicher Fragen. Rechtsmedizin 6:39–44Google Scholar
  152. Schmitt HP (1973) Die Bedeutung von Varianten im Bereich der Arteriae vertebrales und der Arteria basilaris für die forensische Medizin. Z Rechtsmed 73:23–28PubMedCrossRefGoogle Scholar
  153. Schnapka G, Dietze O, Propst A (1983) Morphometrische Untersuchungen bei idiopathischer Medianekrose. Pathologe 4:303–306PubMedGoogle Scholar
  154. Schön C, Ramaswamy A, Barth PJ (2005) Churg-Strauss-Syndrom. Rechtsmedizin 15:173–176CrossRefGoogle Scholar
  155. Schultz TC (1989) Coronary artery aneurysms in a young adult. Am J Forensic Med Pathol 10:63–66PubMedCrossRefGoogle Scholar
  156. Schürch W (1970) Familäre dissezierende Aneurysmen der Aorta. Arch Kreislaufforsch 63:288–319PubMedCrossRefGoogle Scholar
  157. Seguchi M, Hino Y, Aiba S, Yasukohchi S, Momma K, Takao A, Endo M (1990) Ostial stenosis of the left coronary artery as a sole clinical manifestation of Takayasu’s arteritis: a possible cause of unexpected sudden death. Heart Vessel 5:188–191CrossRefGoogle Scholar
  158. Shields LBE, Rolf CM, Davis GJ, Hunsaker JC (2010) Sudden and unexpected death in three cases of Ehlers-Danlos Syndrome type IV. J Forensic Sci 55:1641–1645PubMedCrossRefGoogle Scholar
  159. Shields LBE, Burge M, Hunsaker JC (2012) Sudden death due to polyarteritis nodosa. Forensic Sci Med Pathol 8:290–295PubMedCrossRefGoogle Scholar
  160. Sorger K (1968) Über Veränderungen der Vasa vasorum bei Medianecrosis aortae. Virchows Arch Abt A Path Anat 345:107–120CrossRefGoogle Scholar
  161. Soucy P, Eidus L, Keeley F (1990) Perforation of the colon in an 15-year-old girl with Ehlers-Danlos syndrome type IV. J Pediatr Surg 25:1180–1182PubMedCrossRefGoogle Scholar
  162. Stegmann T (1987) Aortendissektion: Nicht mit dem Herzinfarkt verwechseln. Dtsch Ärztebl 84:282–285Google Scholar
  163. Srettabunjong S (2013) Spontaneous rupture of acute ascending aortic dissection in a young pregnant woman: a sudden unexpected death. Forensic Sci Int 232:e5–e8PubMedCrossRefGoogle Scholar
  164. Sunagawa K, Mitsumata M, Ayusawa M, Kusumi Y (2008) Ruptured giant aneurysm of the left anterior descending coronary artery in Kawasaki disease. Pediatr Cardiol 29:1115–1119PubMedCrossRefGoogle Scholar
  165. Suzuki A, Miyagawa-Tomita S, Nakazawa M, Yutani C (2000) Remodeling of coronary artery lesions due to Kawasaki disease: comparison of arteriographic and immunohistochemical findings. Jpn Heart J 41:245–256PubMedCrossRefGoogle Scholar
  166. Tanaka N, Naoe S, Masuda H, Ueno T (1986) Pathological study of sequelae of Kawasaki disease (MCLS). With special reference to the heart and coronary arterial lesions. Acta Pathol Jpn 36:1513–1527PubMedGoogle Scholar
  167. Tanaka A, Fukajama M, Funata N, Koike M, Saito K (1988) Coronary arteritis and aortoarteritis in the elderly males. Virchows Arch A Path Anat Histopathol 414:9–14CrossRefGoogle Scholar
  168. Thierauf A, Preuss J, Dettmeyer R, Madea B (2007) Fatal rupture of an undiagnosed aneurysm of the splenic artery – medico-legal implications. Forensic Sci Int 171:133–136CrossRefGoogle Scholar
  169. Vock R, Schulz E (1986) Marfan syndrome. A case report. Z Rechtsmed 96:67–78PubMedCrossRefGoogle Scholar
  170. von Kodolitsch Y, Robinson PN (2007) Marfan syndrome: an update of genetics, medical and surgical management. Heart 93:755–760CrossRefGoogle Scholar
  171. Wagner AD, Goronzy JJ, Weyand CM (1994) Functional profile of tissue-infiltrating and circulating CD68+ cells in giant cell arteritis: evidence for two components of the disease. J Clin Invest 94:1134–1140PubMedPubMedCentralCrossRefGoogle Scholar
  172. Wang L, Thelmo WL, Axiotis CA (2002) Microscopic polyangiitis with massive myocardial necrosis and diffuse pulmonary hemorrhage. Virchows Arch 441:202–204PubMedCrossRefGoogle Scholar
  173. Wang Y, Chen S, Wang R, Huang S, Yyang M, Liu L, Liu Q (2016) Postmortem diagnosis of Marfan syndrome in a case of sudden death due to aortic rupture: detection of a novel FBN1 frameshift mutation. Forensic Sci Int 261:e1–e4PubMedCrossRefGoogle Scholar
  174. Wimmer PJ, Howes DS, Rumoro DP, Carbone M (1996) Fatal vascular catastrophe in Ehlers-Danlos syndrome: a case report and review. J Emerg Med 14:25–31PubMedCrossRefGoogle Scholar
  175. Wood LE, Tulloh RM (2009) Kawasaki disease in children. Heart 95:787–792PubMedCrossRefGoogle Scholar
  176. Yonesaka S, Takahashi T, Furukawa H, Matubara T, Tomimoto K, Oura H, Nakada T, Sunagawa Y (1992) Histopathological analysis of myocardial damages following Kawasaki disease with repeated endomyocardial biopsy. Kokyu To Junkan 40:375–381PubMedGoogle Scholar
  177. Yoshikawa H, Nomura Y, Masuda K, Hazeki D, Yotsumoto K, Arata M, Kamenosono A, Yanagi S, Yoshinaga M, Kawano Y (2006) Four cases of Kawasaki syndrome complicated with myocarditis. Circ J 70:202–205PubMedCrossRefGoogle Scholar
  178. Yost BA, Vogelsang JP, Lie JT (1995) Fatal hemoptysis in Ehlers-Danlos syndrome. Chest 107:1465–1467PubMedCrossRefGoogle Scholar
  179. Yutani C, Go S, Kamiya T, Hirose O, Misava H, Maeda H, Kozuka T, Onishi S (1981) Cardiac biopsy of Kawasaki disease. Arch Pathol Lab Med 105:470–474PubMedGoogle Scholar
  180. Zack F, Terpe H, Hammer U, Wegener R (1996) Fibromuscular dysplasia of coronary arteries as a rare cause of death. Int J Legal Med 108:215–218PubMedCrossRefGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Reinhard B. Dettmeyer
    • 1
  1. 1.University Hospital Giessen Institute of Forensic MedicineGiessenGermany

Personalised recommendations