OBJECTIVE: To explore the cause of death, clinical manifestations and forensic pathological features of death cases caused by aortic dissection. METHODS: Sixty-three cases of aortic dissection were selected from forensic medical center, Sun Yat-sen University from 2001 to 2011 and retrospectively analyzed. RESULTS: The patients were mostly young and middle-aged male, aged from 30 to 49 years old. The DeBakey type II was the most common pathological type and the main cause of death was pericardial tamponade. The most common symptom was abdominal pain. However, the location of aorta dissection did not always correlate with the location of pain. Some cases showed no obvious clinical symptoms. The rupture was usually located in ascending aorta with atherosclerosis and pathological changes of hypertension. CONCLUSION It is significant for diagnosis and evaluation the cause of death of aortic dissection by knowing the clinical symptoms and forensic pathological features.
Adult ; Age Factors ; Aged ; Aortic Dissection/pathology* ; Aorta/pathology* ; Aortic Aneurysm/pathology* ; Aortic Rupture/pathology* ; Cardiac Tamponade/pathology* ; Death, Sudden/pathology* ; Diagnostic Errors ; Female ; Forensic Pathology ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Risk Factors ; Severity of Illness Index ; Young Adult

Thoracic aortic dissection (TAD) is one of the most lethal aortic diseases due to its acute onset, rapid progress, and high rate of aortic rupture. The pathogenesis of TAD is not completely understood. In this mini-review, we introduce three emerging experimental mouse TAD models using β-aminopropionitrile (BAPN) alone, BAPN for a prolonged duration (four weeks) and then with added infusion of angiotensin II (AngII), or co-administration of BAPN and AngII chronically. We aim to provide insights into appropriate application of these three mouse models, thereby enhancing the understanding of the molecular mechanisms of TAD.
Aminopropionitrile/toxicity* ; Aortic Dissection/pathology* ; Angiotensin II/toxicity* ; Animals ; Aortic Aneurysm, Thoracic/pathology* ; Disease Models, Animal ; Male ; Mice ; Mice, Inbred C57BL

Objective: To investigate the pathological changes of placenta in pregnant women with aortic dissection/aneurysm and their relationship with clinical features. Methods: The placental samples of 14 pregnant women with aortic dissection/aneurysm diagnosed from January 2012 to October 2021 and 10 normal placental samples of pregnant women from January 2021 to December 2021 at Beijing Anzhen Hospital Affiliated to Capital Medical University, Beijing, China were selected. Routine H&E staining and immunohistochemistry were used to analyze the histological features under light microscope. The clinical data were also analyzed. Results: The age of 14 pregnant patients with aortic dissection/aneurysm for placental examination ranged from 22 to 38 years (median, 28 years). The gestational ages ranged from 22 to 39 weeks (median, 34 weeks). The pregnancy of second trimester was noted in 2 cases, and the third trimester in 12 cases. All cases were singleton pregnancy. Seven cases were Stanford type A aortic dissection, 6 cases were Stanford type B aortic dissection, and one case was aortic root aneurysm. Four of the pregnant women underwent aortic dissection surgery after caesarean section, three underwent caesarean section after aortic dissection surgery, and seven underwent both caesarean section and aortic dissection procedures. Among the newborns, 2 cases were full-term birth, and 12 cases were premature birth. Twelve cases had alive newborns, and 2 cases stillbirths. Fetal/placental weight ratio (FPR)<10th percentile was in 5 cases and FPR>90th percentile in one case. Compared with the normal group, accelerated villus maturation and distal villus dysplasia were more frequently found in pregnancy with aortic dissection group (P<0.05). There was no significant difference in villi infarction and decidua vascular lesions between the two groups (P>0.05), nor was there correlation between the type of aortic dissection and distal villus dysplasia and accelerated villus maturation of placentas (P>0.05). The number of villous interstitial blood vessels in the placentas of pregnancy with aortic dissection group was significantly fewer than that in the normal control group (P<0.01). Conclusions: There are considerable pathological changes in the placentas of pregnant women with aortic dissection/aneurysm. The main histological features are accelerated villus maturation and distal villus dysplasia, which are manifestations of villous ischemia and hypoxia, and also a part of the placental pathological manifestations of maternal vascular dysperfusion.
Pregnancy ; Female ; Infant, Newborn ; Humans ; Infant ; Young Adult ; Adult ; Placenta/pathology* ; Cesarean Section ; Aortic Dissection/surgery* ; Gestational Age ; Aortic Aneurysm/pathology*

OBJECTIVE: To explore procedures and methods of forensic investigation for the death cases of aortic dissection with disputes. METHODS: Twenty-one death cases of aortic dissection with disputes from 2006 to 2011 were collected. All the data were analyzed to investigate the reasons and features of the disputes. RESULTS: The main causes of the disputes were clinical misdiagnosis or slight force. The pathologic type of De Bakey (I and II) or Stanford A were common in each case. For the cases dying of aortic dissection, it was significantly important to detect the rupture of entry and exit and observe the dissection of arterial wall. CONCLUSION The main causes of clinical misdiagnosis are insufficient experiences, careless observation and curtness in medical treatment. The difficult points in these cases are confirmation of the relationships between injury and disease, the primary affection and complication.
Adult ; Aged ; Aged, 80 and over ; Aortic Dissection/pathology* ; Aorta/pathology* ; Aortic Aneurysm/pathology* ; Autopsy ; Cause of Death ; Diagnostic Errors ; Female ; Forensic Pathology/methods* ; Humans ; Male ; Malpractice/legislation & jurisprudence* ; Middle Aged ; Violence ; Young Adult