Dissecting aneurysm was described by Morgagni in 1761. Although the cystic medial
necrosis has been thought as the major cause of dissecting aneurysm, diffuse
atherosclerotic change of the aortic intima may contribute the medical degeneration.
Recently, the authors experienced a case of dissecting aneurysm associated with diffuse
atherosclerotic change in the intima, in an autopsy case. A 60 years old male patient
was admitted to the hospital because of indigestion and chilling sensation for 7days.
Three days prior to this entry, he experienced a sudden crushing chest pain, that was
spontaneously releaved several hours later. He denied any past history of coronary heart
disease, valvular heart disease or syphilitic infection. On admission, physical
examinations revealed slightly puffy face, distended jugular veins, and palpable liver.
Chest x-ray film revealed elongation and distortion of the greater vessels accompanied
by cardiomegaly. Laboratory findings including complete blood count, blood chemistry,
urinalysis, and VDRL were within normal limits. During admission, he was observed
with supportive therapy. On the 8th hospital 6ay, 18 days after first symptoms
developed, he suddenly fell into unconscious state during defecation, and died soon after.
The autopsy was limited to the cardiovascular system. The heart weighed 670 gm,
and about 1,500 cc of blood and clots were noted in the pericardial cavity. There was a
rupture, 2.5× 1.7 cm, in the ascending aorta near the aortic valve, on the point 5 cm
distal from the aortic valve. The wall of the aorta was dissected near the aortic valve
to the lower abdominal aorta (De Bakey Type I). Diffuse atherosclerotic change of the
aortic intima was observed, but atheromatous ulcer was not observed. Microscopic
findings revealed diffuse hyalin degeneration of the aortic media, intimal thickening and
subintimal aggregations of foam cells with focal calcification.
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