Retrospective review of deaths relating to aortic dissection over a 16 year period

Abstract

The diagnosis of aortic dissection is difficult because of often non-specific clinical features. It is often confused with a range of both benign and potentially lethal conditions. Experience demonstrates that in those cases referred for coronial investigation, it is relatively uncommon that aortic dissection be considered antemortem. A retrospective review of cases of autopsy verified death due to aortic dissection performed at the Department of Forensic Medicine, Glebe, is presented. This 16 year review includes data on demographics, pre-existing, familial and syndromic conditions, potential risk factors, the characteristics of disease as well as the circumstances surrounding presentation and death. Results include a strong correlation with pre-existing cardiovascular disease and the relative rarity of the various connective tissue diseases typically cited as being significant causes of aortic dissection. The clinical course appears to be rapid with almost 1:4 deaths occurring in the emergency department and around 1:5 deaths occurring during or after surgery. This study has the additional significance of providing detailed baseline information in a large number of cases on the nature of aortic dissection for the purposes of a subsequent study where autopsy and post-mortem MRI features are compared in a smaller prospective series of cases.