Sudden death due to spontaneous rupture in splenic artery atypical dissection with features of vasculitis: Case report and review of the literature

A case of sudden death in a 45-year-old man due to splenic artery dissection and rupture diagnosed at a medico-legal autopsy is described. The examination of the splenic artery revealed macroscopically the features of a ruptured intramural haematoma (no intimal tear, no lumen dilation) and histologically the characteristics of a lymphoplasmacytic vasculitis of the vasa vasorum associated with fibrinoid degeneration. The patient died at home after having been discharged from hospital where he had presented for modest abdominal pain with no evidence of the true nature of the disease found using echography. The Authors discuss the literature relative to splenic artery dissection (13 cases of which only one diagnosed in vivo), the present case being the only one due to vasculitis of the vasa vasorumand the forensic implications (autopsy was ordered to examine the causes of death, to verify whether diagnosis could have been reached during hospitalization with consequences on the outcome and if a hypothesis of malpractice could be prospected).