title: An unusual presentation of thoracic aortic aneurysm rupturing into the esophagus: an autopsy case report.
abstract: Ruptured aortic aneurysms often present with sudden death, and have varied signs and symptoms depending on the site of rupture and hemorrhage. We report a case of an aortic aneurysm with an aorto-esophageal fistula, which showed slow gastrointestinal bleeding for days before death. A 79-year-old male was brought to a hospital emergency unit, with a history of melena for about 3 days, and recent hematemesis. He collapsed immediately after endoscopy and died. A forensic autopsy which was performed due to possible medical malpractice demonstrated a large saccular aneurysm of the descending thoracic aorta with a fistula into the esophagus. A significant finding was a lid or valve shaped thrombus covering the aortic orifice of the fistula, which may have partly contributed to slow bleeding, and which may have been dislodged by endoscopy. This case suggests that very careful management of aorto-esophageal fistula is needed in patients with clinical signs of possible thoracic aortic aneurysm with slow hemorrhage.
authors.affiliation: Department of Legal Medicine, Osaka City University Medical School, Asahi-machi 1-4-3, Abeno, Osaka 545-8585, Japan.
authors.forename: Sumithra Gamini Hewa
authors.initials: SG
authors.lastname: Ambepitiya
authors.forename: Tomomi
authors.initials: T
authors.lastname: Michiue
authors.forename: Yasumori
authors.initials: Y
authors.lastname: Bessho
authors.forename: Yasunobu
authors.initials: Y
authors.lastname: Kamikodai
authors.forename: Takaki
authors.initials: T
authors.lastname: Ishikawa
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Maeda
mesh_terms: D000368:Aged; D017542:Aneurysm, Ruptured / Q000473:pathology*; D001011:Aorta / Q000473:pathology; D017545:Aortic Aneurysm, Thoracic / Q000473:pathology*; D001018:Aortic Diseases / Q000473:pathology; D016099:Endoscopy, Gastrointestinal; D004937:Esophageal Fistula / Q000473:pathology*; D004947:Esophagus / Q000473:pathology; D049429:Forensic Pathology; D006471:Gastrointestinal Hemorrhage / Q000473:pathology; D006396:Hematemesis / Q000209:etiology; D006801:Humans; D008297:Male; D008551:Melena / Q000209:etiology; D009504:Neutrophils / Q000473:pathology; D016157:Vascular Fistula / Q000473:pathology*