title: Pericardial tear as a consequence of cardiopulmonary resuscitation (CPR) involving chest compression: a report of two postmortem cases of acute type A aortic dissection with hemopericardium.
abstract: We present two cases of a pericardial tear as a consequence of cardiopulmonary resuscitation involving chest compressions in fatal acute type A aortic dissection (AoD) with hemopericardium. For each case, postmortem computed tomography revealed a hematoma in the false lumen of the ascending aorta with a slight hemopericardium and a large left hemothorax, as well as focal pericardial dimpling and discontinuity around the left ventricle. At autopsy, we confirmed a convex lens-shape gaping pericardial tear at the left posterolateral site of the pericardium and a massive volume of bloody fluid in the left thoracic cavity. It has been hypothesized that the pericardium ruptured due to chest compressions during resuscitation in these cases of acute type A AoD with hemopericardium and that intrapericardial blood leakage through the pericardial tear resulted in a hemothorax.
authors.affiliation: Office of the Chief Medical Examiner, State of Maryland, USA; Department of Legal Medicine, Nippon Medical School, Japan; Tsukuba Medical Examiner's Office, Tsukuba, Japan. Electronic address: takahisa.okuda@gmail.com.
authors.forename: Takahisa
authors.initials: T
authors.lastname: Okuda
authors.affiliation: Department of Pathophysiology, Oita University School of Medicine, Oita, Japan.
authors.forename: Hiroki
authors.initials: H
authors.lastname: Takanari
authors.affiliation: Department of Radiology, Tsukuba Medical Center, Tsukuba, Japan.
authors.forename: Seiji
authors.initials: S
authors.lastname: Shiotani
authors.affiliation: Tsukuba Medical Examiner's Office, Tsukuba, Japan.
authors.forename: Hideyuki
authors.initials: H
authors.lastname: Hayakawa
authors.affiliation: Department of Legal Medicine, Nippon Medical School, Japan.
authors.forename: Youkichi
authors.initials: Y
authors.lastname: Ohno
authors.affiliation: Office of the Chief Medical Examiner, State of Maryland, USA.
authors.forename: David R
authors.initials: DR
authors.lastname: Fowler
mesh_terms: D000368:Aged; D000784:Aortic Dissection / Q000150:complications*; D001014:Aortic Aneurysm / Q000150:complications*; D001018:Aortic Diseases; D001344:Autopsy; D016887:Cardiopulmonary Resuscitation / Q000009:adverse effects* / Q000379:methods; D006491:Hemothorax / Q000209:etiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D010490:Pericardial Effusion / Q000209:etiology*; D010496:Pericardium / Q000293:injuries*
keywords: Aortic dissection; Cardiopulmonary resuscitation (CPR); Chest compression; Pericardial tear; Postmortem computed tomography (PMCT)