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(Circulation. 1998;97:705-706.)
© 1998 American Heart Association, Inc.

Images in Cardiovascular Medicine

Sudden Death Due to Rupture of Coronary Aneurysm in a 26-Year-Old Man

Masahiko Satoda, MD; Hirotaka Tatsukawa, MD; ; Shuji Katoh, MD

From Asahi University, the Division of Cardiology, Murakami Memorial Hospital, Hashimoto-cho, Gifu, Japan.

Correspondence to Masahiko Satoda, MD, 2nd Department of Internal Medicine, Kyoto Prefectural University of Medicine, Kawaramachi: Hirokozi, Kamikyo-ku, Kyoto, Japan.

A 26-year-old man, previously in good health, was transferred to the emergency unit of our hospital on July 19, 1995; however, he was dead on arrival. He was an employee of a machine industry with no history of chest pain or palpitation, and at company checkups, no abnormalities were pointed out except for marked left hilar calcification on chest radiograph in June 1991 (Fig 1); moreover, when he was 1 year old, he suffered from an acute self-limited febrile illness with diffuse erythematous macular rash followed by membranous desquamation of the fingertips and notable conjunctival infection resembling Stevens-Johnson syndrome or mucocutaneous lymph node syndrome that occurred 2 years after the first description of Kawasaki disease.¹ About half an hour before admission, he had suddenly lost consciousness while playing catch during the noon break. Despite cardiopulmonary resuscitation, he died, and an autopsy was performed immediately.

View larger version (104K): [in this window] [in a new window]   Figure 1. Chest radiograph showing small left hilar calcification (arrow).

A small, fresh hematoma was seen on the epicardial surface close to the proximal left anterior descending coronary artery (Fig 2A). The true lumen was heavily calcified and stenotic, and the pseudolumen was coated internally with a smooth intimal membrane (Fig 2B). A postmortem angiogram (Fig 3) revealed that the saccular aneurysm communicated with the true lumen. The circumflex artery was also depicted, suggesting that there was no thrombotic occlusion of the left descending artery, and secondary strangulation of the true lumen due to the aneurysm rupture might have evoked an anteroseptal . . . [Full Text of this Article]

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