ML - Non-inquest findings

71y · Female·Haemothorax and haemopericardium secondary to ruptured dissecting aneurysm of thoracic aorta

A 71-year-old woman with hypertension and prior myocardial infarction presented to emergency with sudden chest pain, jaw pain, and syncope. Aortic dissection was appropriately suspected and a contrast CT-aortagram was performed, which showed no dissection but revealed mediastinal widening and aortic dilation. She was admitted for further investigation including formal echocardiography planned for the next day. She deteriorated acutely overnight and died from a ruptured thoracic aortic dissection with massive haemothorax and haemopericardium. Post-mortem review identified that a pre-contrast CT scan before the contrast study might have detected early mural haematoma, and an interval CT scan hours after the initial study might have shown evolving dissection. The coroner found initial management appropriate but noted that discussion with tertiary specialists regarding the persistent undifferentiated chest pain, hypotension, and radiological findings might have prompted earlier intervention.