A Clinicopathological Analysis of Six Autopsy Cases of Sudden Unexpected Death due to Infectious Aortitis in Patients with Aortic Tears
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- Ishikawa Marin
- Department of Cancer Pathology, Hokkaido University Graduate School of Medicine, Japan
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- Tanino Mishie Ann
- Department of Cancer Pathology, Hokkaido University Graduate School of Medicine, Japan
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- Miyazaki Masaya
- Department of Renal and Genitourinary surgery, Hokkaido University Graduate School of Medicine, Japan
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- Kimura Taichi
- Department of Cancer Pathology, Hokkaido University Graduate School of Medicine, Japan
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- Ishida Yusuke
- Department of Cancer Pathology, Hokkaido University Graduate School of Medicine, Japan
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- Wang Lei
- Department of Cancer Pathology, Hokkaido University Graduate School of Medicine, Japan
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- Tsuda Masumi
- Department of Cancer Pathology, Hokkaido University Graduate School of Medicine, Japan
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- Nishihara Hiroshi
- Department of Translational Pathology, Hokkaido University Graduate School of Medicine, Japan
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- Nagashima Kazuo
- Department of Diagnostic Pathology, Sapporo Higashi Tokushukai Hospital, Japan
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- Tanaka Shinya
- Department of Cancer Pathology, Hokkaido University Graduate School of Medicine, Japan Department of Translational Pathology, Hokkaido University Graduate School of Medicine, Japan
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Abstract
<p>Objective Cardiovascular disease is a leading cause of sudden unexpected death even in hospitalized patients. Infectious aortitis is a rare disease that has the potential to cause aortic tears and hemorrhage followed by sudden death. The aim of this study was to reveal the clinicopathological features of infectious aortitis that are related to sudden unexpected death. </p><p>Methods We retrospectively reviewed 1,310 autopsy cases over 15 years and selected the cases involving patients who died suddenly due to aortic tears. We analyzed the clinical information and pathological findings. </p><p>Results One hundred thirty-three of 1,310 cases (10.2%) were autopsied under the clinical diagnosis of unexpected sudden death. Aortic tears were identified in 33 cases (2.5%) and infectious aortitis was diagnosed in 6 (18.2%) of these cases. All cases involved male patients (middle-aged to elderly) with risk factors for atherosclerosis (i.e., hypertension). The laboratory data showed continuous leukocytosis and C-reactive protein elevation, even during the improvement phase, in patients with pre-existing infectious disease. The autopsy findings revealed three types of aortic tears (aneurysms, dissections and penetrating atherosclerotic ulcers with moderate to severe atherosclerosis), and the infiltration of numerous neutrophils at the site of rupture. Gram-positive bacteria were detected in four cases and Gram-negative bacteria were detected in two cases. </p><p>Discussion We demonstrated that sudden unexpected death caused by infectious aortitis rarely occurred in hospitalized patients, even in the recovery phase of the preceding infectious disease. We therefore recommend that clinicians pay attention to infectious aortitis in patients with infectious disease, particularly elderly patients with atherosclerotic disease, even those who are in the improvement phase. </p><p>Conclusion Unexpected sudden death by infectious aortitis in the recovery phase of antecedent infection. </p>
Journal
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- Internal Medicine
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Internal Medicine 57 (10), 1375-1380, 2018-05-15
The Japanese Society of Internal Medicine