1. State of WestVirginia
Office of the Chief Medical Examiner
Morgantown, WV

3.  Subgaleal hemorrhage: bleeding between the
scalp and skull
Trauma & stress to the head

Breaking of blood vessels

Bleed into space between scalp & skull

4.  Hemopericardium: blood within the
pericardial sac

5.  Cardiac tamponade: pressure on the heart
that occurs when blood/fluid builds up in the
space between the myocardium and
pericardium
 Dissecting aortic aneurysm
 End-stage lung cancer
 Acute myocardial infarction
 Heart surgery
 Pericarditis (bacterial or viral)
 Heart tumors

6.  Intima: innermost layer
 Media: middle layer
 Adventitia: outermost layer

8.  Aortic dissection:When blood separates the
laminar planes of the media to form blood-
filled channel within the aortic wall

9.  Men: 40-60 with history of hypertension
 Younger adults with systemic/localized
connective tissue disorders
 Iatrogenic

10. Hypertension
Atherosclerosis

11.  Cystic medial degeneration & inflammation
 Initiated by tear of intima
 Usually ascending aorta – 10 cm from aortic valve
 Transverse with sharp, jagged edges
 Can rupture

13.  Depends on what part of aorta is affected

14.  Sudden onset of excruciating pain
 Cause of death = rupture of dissection
 Dissections can extend into great arteries of
neck or into coronary, renal, mesenteric or
iliac arteries

15. Date of Examination: March 7th, 2016

16.  March 3rd at 10:00 pm: last seen alive by son
 March 4th: investigator called to decedent’s
residence
 March 4th at 7:45 am: other son found
mother at bottom of stairwell leading from
2nd story
 March 4th at 7:55 am: pronounced dead

17.  Laying in supine position
 Head resting on 3rd step
 Buttocks on 1st step
 Legs on floor shifted to the right
 Internal rotation of left ankle
 Telephone found under legs
 No alcohol or recreational/prescription drugs
 Sons said that she did not complain of pain
nor not feeling well

18.  Hypertension
 Supposed to be treated with medication
 No prescription bottle found
 Social EtOH drinker
 No smoking or recreational drugs
 No allergies, previous surgeries or psychiatric
history

19.  59 year old female
 Length = 64.5 inches (5’ 3”)
 Weight = 164 pounds

21.  450 mL dark red liquid & clotted blood found
in pericardial cavity
 0.8 cm full-thickness defect on posterior
aspect of aorta at transverse sinus
 Intimal surface has 4 cm ragged defect

24.  3 cm partial-thickness defect in ascending
aorta
 Through intimal and medial layers

27.  Circumferential dissection in ascending aorta
 Extends:
▪ Into pulmonary trunk
▪ Brachiocephalic trunk
▪ Proximal aspect of right common carotid artery
▪ Distally to: throughout aortic arch, thoracic aorta and
abdominal aorta to level of renal vessels

28.  Heart: 340 grams
 Dilated chambers
 Coronary arteries
 Left main: patent
 LAD: 50% narrowing
 Left circumflex: 40% narrowing
 Right: 75% narrowing

29.  Uterus
 Cluster of small leiomyomas
 6 cm leiomyoma involving majority of body 
compress endometrial cavity

30.  Brain: 1160 grams
 Hemorrhage beneath the scalp
 Mild patchy atherosclerosis of cerebral vessels

33.  Femoral blood
 Heart blood
 Vitreous humor
 Liver
 Bile
 Gastric contents
 Negative

34.  Aortic dissection with rupture
 Hemopericardium
 Cardiac tamponade (diagnosis)
 Hypertensive and arteriosclerotic
cardiovascular disease
 Left ventricular hypertrophy
 Coronary atherosclerosis
 Patchy aortic and cerebral atherosclerosis

35.  Blunt trauma of head
 Subgaleal hemorrhage

36.  59 year-old woman with a history of hypertension.
She was found dead at the bottom of the steps by
her son.The decedent was supine on the steps with
her head on the 3rd step, her buttocks on the 1st
step, and her legs to the right on the ground.The
decedent’s phone was under her legs. She was
pronounced dead at the scene. Board of pharmacy
review is negative back to 2012.

37.  Autopsy revealed an aortic dissection with rupture,
hemopericardium, hypertensive and
arteriosclerotic cardiovascular disease, and no
injuries contributing to death.Toxicological testing
showed no drugs or alcohol.

38.  Decedent died as a result of cardiac
tamponade due to aortic dissection with
rupture due to hypertensive and
arteriosclerotic cardiovascular disease.
 Manner of death = natural

40. What classification of aortic dissection did the
decedent have?
 Type A (DeBakey I)
 Type A (DeBakey II)
 Type B

41. What classification of aortic dissection did the
decedent have?
 Type A (DeBakey I)
 Type A (DeBakey II)
 Type B

42. The cause of death for a patient following an
aortic dissection is which of the following?
 Arrhythmia
 Exsanguination
 Rupture of dissection
 Multi-organ failure

43. The cause of death for a patient following an
aortic dissection is which of the following?
 Arrhythmia
 Exsanguination
 Rupture of dissection
 Multi-organ failure

44. The decedent’s heart weighed 340 grams.
What is normal heart weight for a female?
 150-250 grams
 400-500 grams
 300-400 grams
 250-350 grams

45. The decedent’s heart weighed 340 grams.
What is normal heart weight for a female?
 150-200 grams
 400-500 grams
 300-400 grams
 250-350 grams

46. The decedent’s uterus revealed leiomyomas.
What are leiomyomas?
 Malignant soft tissue neoplasms
 Infiltrative skeletal muscle neoplasms
 Benign smooth muscle neoplasms
 Benign epithelial neoplasms

47. The decedent’s uterus revealed leiomyomas.
What are leiomyomas?
 Malignant soft tissue neoplasms
 Infiltrative skeletal muscle neoplasms
 Benign smooth muscle neoplasms
 Benign epithelial neoplasms

48. What was the cause of death in this case?
 Cardiac tamponade
 Aortic dissection
 Hypertensive cardiovascular disease
 Atherosclerotic cardiovascular disease

49. What was the cause of death in this case?
 Cardiac tamponade
 Aortic dissection
 Hypertensive cardiovascular disease
 Atherosclerotic cardiovascular disease

50.  Kumar, V, Abbas, A, Aster, J. Robbins and Cotran Pathologic Basis
of Disease. 9th ed. Philadelphia, PA: Elsevier Saunders; 2015.
 Photos provided by autopsy staff at WVU-Office of the Chief
Medical Examiner