Acute malaise and nausea with aortic rupture in idiopathic median necrosis ERDHEIM-GSELL

DOI: 10.36210/BerMedJ/epub0042022

Abstract

An 80-year-old patient alerted the emergency services when she felt acutely unwell with cold sweats and vomiting. In addition, the patient stated that she had been experiencing abnormal sensations in her left arm for about fourteen days. Computed tomography performed to rule out a pulmonary embolism and a cerebral embolism revealed an aneurysmal enlargement of the ascending aorta, as well as a local wall hematoma and a hematopericardium without evidence of active bleeding or dissection. The focused transthoracic echocardiography that followed revealed a 2 cm pericardial effusion with the assessment of a non-existent haemodynamic influence. The patient was treated symptomatically and monitored in intensive care, since an indication for acute intervention was not made either by vascular surgery or cardiology. In the further course, the patient became acutely in need of resuscitation. A pericardial puncture was not performed under resuscitation, partly in view of the advanced age, and the resuscitation measures were ended by interdisciplinary consensus. The autopsy revealed the cause of death to be a pericardial effusion due to focal dissection of the ascending aorta with aortic wall rupture on the basis of an idiopathic cystic median necrosis Erdheim-Gsell.