Sudden Unexpected Death: Severe Diffuse Involvement of Coronary Arteries in Clinically Silent Aortoarteritis in a Young African-American Male
X Sun, M Dardik, M Kintiroglou, M Clayton. Saint Barnabas Medical Center, Livingston, NJ; Bergen County Medical Examiner's Office, Paramus, NJ
Background: Aortoarteritis is a chronic inflammatory disorder of large elastic arteries usually affecting the aorta and its larger branches. Sudden cardiac death as the first manifestation of aortoarteritis with severe involvement of coronary arteries is extremely rare. We therefore report a patient who presented with sudden cardiac death as primary manifestation of aortoarteritis.
Design: Forensic autopsy was performed and the cause of death was established. The heart and aorta were then examined grossly and microscopically.
Results: A 24-year-old, African-American well built and muscular male had no known previous history of cardiac disease. He suddenly collapsed to the ground and displayed generalized seizure-like activity. He died despite extensive resuscitative efforts. Autopsy revealed markedly narrowed coronary arteries. All coronary arteries had predominant concentric intimal thickening and narrowing. The left anterior descending coronary artery had fibrotic intimal thickening with up to 90% stenosis. The right coronary artery, posterior descending coronary artery, left circumflex coronary artery, and the first diagonal coronary artery branch were up to 80-85%, 95-99%, 80%, and 50-60% narrowed respectively. There was wrinkled and cobblestone appearance in the intimal surface of ascending aorta, aortic arch and descending aorta with ostial narrowing of the coronary arteries. Microscopically, concentric fibroproliferative type intimal thickening with an inflammatory cell infiltrate within the adventitia were identified in all coronary arteries. Similar changes were present in the aorta. There were also healed subendocardial myocardial infarct and healed fibrous scar in left ventricle. Spirochete stain was negative. Detailed review of history revealed that the patient has no family history of sudden cardiac death. There was no history of alcohol or drug abuse with negative toxicology test. All above findings supported the diagnosis of healed aortoarteritis.
Conclusions: We report one case of fatal healed aortoarteritis. Based on the patient's young age and the microscopic findings, the etiology is most likely Takayasu aortoarteritis. To our best knowledge, severe diffuse involvement of coronary arteries in aortoarteritis with sudden death as first manifestation in young black male has been rarely reported in the literature.
Wednesday, March 24, 2010 9:30 AM
Poster Session V # 5, Wednesday Morning