title: An uncommon accident and unusual cause of death--a fatal domestic ram attack.
abstract: Domestic animal attacks are not common; their fatal attacks are even rarer. Herein, a case of a 78-year-old woman attacked by a ram is presented. She sustained multiple head and chest injuries. The autopsy findings and the inspection of the scene revealed that the fatal aortic injury had been caused by direct force from the front, which subsequently caused a powerful anteroposterior chest compression, resulting in an incomplete tear by flexion and compression of the aortic arch. The aortic dissection propagated in both an ante- and retrograde direction, with intact adventitia. However, due to a rise in pressure in the formed false lumen, dissection propagated downward to the base of the heart, and further into the subepicardial adipose tissue, forming a subepicardial hematoma. This hematoma gradually compressed the proximal sections of the coronary arteries, impairing their filling, and producing a myocardial ischemia. In addition, circulation had probably been already disturbed by the right-sided pneumothorax, as well as a possible pneumomediastinum.
authors.affiliation: Institute of Forensic Medicine, University of Belgrade - School of Medicine, 31a Deligradska str., Belgrade, 11000, Serbia.
authors.forename: Vladimir
authors.initials: V
authors.lastname: Zivković
authors.forename: Slobodan
authors.initials: S
authors.lastname: Nikolić
mesh_terms: D000059:Accidents; D000368:Aged; D000383:Agriculture; D000818:Animals; D001013:Aorta, Thoracic / Q000293:injuries* / Q000473:pathology*; D005260:Female; D049429:Forensic Pathology; D050723:Fractures, Bone / Q000209:etiology / Q000473:pathology; D006406:Hematoma / Q000209:etiology / Q000473:pathology; D006470:Hemorrhage / Q000473:pathology; D006801:Humans; D017202:Myocardial Ischemia / Q000209:etiology; D011030:Pneumothorax / Q000209:etiology / Q000473:pathology; D012756:Sheep; D013249:Sternum / Q000293:injuries / Q000473:pathology; D013904:Thoracic Vertebrae / Q000293:injuries / Q000473:pathology; D014949:Wounds, Nonpenetrating / Q000209:etiology / Q000473:pathology*
keywords: animal attack; aortic dissection; aortic rupture; forensic pathology; forensic science; subepicardial hematoma