Death caused by natural aortic rupture : casistic study of legal medicine of Milan from 1994 to 2005

The aorta rupture represents an emergency situation that very often leads the subject struk by it to the exitus in a very short time. It is necessary, in clinical practice, that the diagnosis is made in right time and efficacious remedy is immediately established. All this makes these pathologies very important in legal medicine because they are frequent causes of death; anatomo-pathological data, individualized in course of autopsy, show their importance because these conditions remain unknown until the death moment. Medical professional responsibility is another important forensic medical aspect; the cause of the importance of this problem is due by aneurysms and dissections frequently show an aspecific symptomatology which is very often confused for others pathologies, all this conduces to wrong diagnostic charts and to mistakes in diagnosis and therapy. This study was effectuated with retrospective way including every dead subject observed in medico-legal district of Milan from 1994 january to 2005 december, in wich the cause of death was represented by a natural aortic rupture. For each case included in this study, we obtained circumstantial informations about death, anamnestic data and anatomo-pathological information about the way and the site of rupture and about the cause of death. We observed 215 cases of natural aortic rupture corresponding to 1,58% of autopsy effectuated in observation period (13636), in particular, 81 women (37,67%) and 134 men (62,33%). In 131 cases (60,93%) rupture occured at intrapericardic aorta level, in 30 cases (13,95%) at the bow or at the descending thoracic tract, in the remaining 54 cases (25,12%) rupture was observed at abdominal tract level. Average age of population examinated is 70,46 years old; 72,93 years old in deaths caused by aterosclerotic aneurysm and 67,40 in deaths caused by dissection. On the average, the rupture occurs earlier in males than in females (males: 70,83 years old by aneurysms and 64,33 years old by dissections; females: 75,25 years by aneurysms and 74,02 years old by dissections). 119 cases (55,35%) present a positive anamnesis for cardio-vascular pathologies; among these, 53 (24,65%) are affected by hypertension while 19 (8,83%) have an history of aortic aneurysms. Owns data show that the natural aortic ruptures results to be a relatively frequent cause of death. Subjects who have a major risk results to be males, which show a major incidence of rupture both caused by aterosclerotic aneurysm and caused by dissection. Average age of death is attested about 70 years old, even if in the subjects affected by the dissecative pathology, the rupture occurs too early, especially in males. The greater part of subjects founded dead or those who died before reaching hospital demonstrate that death occurs in a very short time, excluding the possibility of a medical or surgical efficacious intervention.