Acute Aortic Dissection in Young Patients without any Predisposing Factors

Case Report

Austin J Clin Case Rep. 2019; 6(4): 1153.

Acute Aortic Dissection in Young Patients without any Predisposing Factors

Nihel F1*, Malek Z1, Wiem BA1, Selma C2, Wiem F3, Sami B1, Zouhair H1 and Samir M1

1Department of Forensic Pathology, Habib Bouguiba University Hospital, Tunisia

2Department of Cardiology, Hedi Chaker University Hospital, Tunisia

3Department of Radiology, Hedi Chaker University Hospital, Tunisia

*Corresponding author: Nihel Feki, Department of Forensic Pathology, Habib Bouguiba University Hospital, 3029 Sfax, Tunisia

Received: August 26, 2019; Accepted: September 26, 2019;Published: October 03, 2019


Acute dissection of the aorta is one of the most dramatic cardiovascular emergencies. It is rare in the young subject. Untreated dissection is nearly always fatal. Heritable disorders of connective tissue, trauma and hypertension are classic predisposing factors or etiologies. Nevertheless, in medical and forensic practice aortic dissections without predisposing factors are not exceptional and need to be reported.

We present here two different cases of aortic dissection in two young patients without any predisposing factors. The first was an autopsy case. The second presented an acute type A aortic dissection with a circumferential intimal flap and was treated successfully.

Keywords: Aortic dissection; Young age; Sudden death; Autopsy; Surgical treatment


AoD: Aortic Dissection


Aortic dissection (AoD) is rare in the pediatric and young adult population [1]. With or without with predisposing risk factors, it usually occurs suddenly in patients. It is characterized by an abrupt onset and progress rapidly. The characteristic clinical presentation is generally a severe pain as knifelike tearing. Prompt evaluation and therapy may be lifesaving but sometimes death happens quickly and the diagnosis is made during autopsy.

We aim to highlight two cases of aortic dissection in two young patients.

The first was an autopsy discovery. In the second case, a prompt diagnosis of type A aortic dissection was made and the patient received a surgical treatment in emergency.

We discuss through these cases the particular aspects of the aortic dissection in the young patients, clinical manifestations, and forensic pathological features of death cases caused by aortic dissection.

Cases Presentation

Case 1

The 18-year-old previously healthy man was referred to the department of forensic pathology after sudden death to determine the cause of death.

His family reported that he complained of sudden headache and minor discomfort in his chest then collapsed when talking. His medical history was unremarkable except obesity. He had no history of tobacco, drug or alcohol abuse. He had also no history of chest trauma or hypertension. He was not apparently suffering from any connective tissue disorders. At autopsy, there were neither marfanoïd features nor external injuries on the body.

On internal examination, brain and lungs were congested and edematous.

The autopsy revealed a 300mL blood volume and huge hematoma in the pericardium encompassing the whole heart (Figure 1) and owing to a retrograde type A dissection. An intimal tear of 4 x 2 cm with surrounding hemorrhages was present at the ascending portion of the aorta (Figure 2) and the absence of bicuspid aortic valve was noted (Figure 3). The other findings included normal heart structure with 325g in weight and other internal organs were congested. The toxicological analysis was negative.