A case report of a sudden adolescent death from a rare cause: rupture of a saccular thoracic aneurysm complicating undiagnosed coarctation of the aorta

Abstract

Introduction: Coarctation of the aorta is one of the most commonly encountered congenital heart diseases accounting for about 7% of the cases. With early childhood diagnosis and the development of corrective surgical intervention, undiagnosed aortic coarctation presenting as sudden and unexpected death is today a rarity. Fatal complications such as aortic rupture or dissection, endocarditis and ruptured cerebral aneurysm can arise when left untreated. We report a rare case of sudden death involving an adolescent female found to have an undiagnosed aortic coarctation at autopsy with a saccular thoracic aneurysm and hemothorax. Case description: A healthy 17-year-old girl was dead on arrival at the Emergency Department of a district hospital after collapsing at home following a short history of breathing difficulties. A forensic autopsy revealed massive left-sided hemothorax and a heretofore undiagnosed aortic coarctation with a pre-coarctation saccular thoracic aneurysm that has ruptured. On histology, the aneurysm wall was found to be deficient in tunica media with no evidence of dissection. Discussion and conclusion: The clinicopathology of coarctation-associated aneurysms will be discussed. Despite their rarity, the forensic pathologist should consider the likelihood of aortic coarctation when confronted with the unexpected finding of a ruptured thoracic aortic aneurysm in the young.