A soccer victim: late rupture of the ascending aorta after violent physical trauma

A 56-year-old man without previous medical history or risk factors for coronary artery disease, presented with chest pain 2 weeks after violent blunt chest trauma. He was as a spectator, beaten and kicked almost to death during an amateur soccer match. Because of embarrassment, this was denied till shortly after his death. Shortly before the patient died, thoracic CT-scan showed a dissecting aneurysm of the ascending aorta in association with pericardial and bilateral pleural effusion. He suddenly died in-hospital due to heart tamponade secondary to rupture of the aneurysm into the pericardial space. At autopsy, the intimal layer of the aorta showed no atherosclerotic changes. The intimal rupture was located just above the origin of the right coronary artery.