Aortic Dissection With Different Histopathology Findings.

Introduction Aortic dissection keeps being a life-threatening condition presenting with a 1-2% of mortality rate per hour after onset. Risk factors and some associations (e.g.: Marfan syndrome) for aortic dissection correlates with men and older patients more likely to develop the disease. It can be classified according with the Stanford System as type A when the dissection involves the ascending aorta and type B when only the descending aorta is involved. The DeBakey System classifies the aortic dissection as type I (starting in ascending aorta and affecting all aortic segments), type II (ascending aorta is dissected) and type III (involving the descending aorta). The histopathologic findings of an acute aortic dissection depend on how far from the first episode the clinical evolution determines the surgical correlation. Usually, in acute immediate status, fibrin and platelets forming thrombi occupying the tunica media dissection within the first 12 hours, with neutrophils in the following days. Objectives A case of aortic dissection with time of evolution required to form a mesenchymal matrix lining the neo-lumen is described. Materials and Methods A 42 years-old male presented at the Emergency Department with cough, chills, and fever. During clinical evaluation, angio-CT was performed revealing an acute aortic dissection, classified type A (Stanford System). Results On gross examination, segments of aortic wall with dimensions varying from 2 cm to 4 cm in greatest dimension and embedded in clots, were sectioned for histopathological examination. Dissection of medial layer with false lumen was clearly observed along with endothelial cells expressing CD34/CD31, ending in a cul-de-sac with fibrin deposition. Conclusions Dating the aortic dissection is a pathological challenge in cases happening in patients presenting with an abrupt clinical onset. In this case, an aortic dissection that had time to form a mesenchymal matrix lined by endothelial cells in the false lumen wall inform about dissection still ongoing due to the presence of fibrin in the ending of the false lumen have to another rupture.