The aortic coarctation and the Etruscan man: morphohistologic diagnosis of an ancient cardiovascular disease

Abstract

Reports of cardiovascular diseases in ancient time are very rare since the material mainly consists of skeletal remains; therefore, these diagnoses can only be carried out indirectly, through the marks left on bones. Here we show a case of coarctation of the aorta diagnosed on bones. Aortic coarctation is a congenital disorder in which a portion of the aorta is narrowed to various extent. A collateral circulation system is enrolled to allow adequate compensation of the blood flow. Collateral vessels may become enlarged, producing a distinctive notching on the pleural surface of the ribs and on adjacent bones. Excavation of a sixth to fifth century B.C. Etruscan tomb revealed three funerary chambers (celle) housing 14 skeletal remains of adults. The ribs of one of the male skeleton showed "nail stroke" indentations. Detailed macroscopic examination enabled us to identify them as notching and led to the diagnosis of postductal aortic coarctation. Histological analysis of bone tissue from the notching areas excluded inflammatory and pathological erosive events, supporting the macroscopic diagnosis. The present paper is the first description of aortic coarctation in paleopathology.