Takayasu aortitis with acute dissection and hemopericardium

We report a case of a 57-year-old woman with an unremarkable past medical history who presented to the emergency department with maxillary pain that later radiated to the chest. She died less than 12 h after admission. CT findings were consistent with ascending aorta dissection with hemopericardium. Autopsy revealed a tear immediately proximal to the ostium of the brachiocephalic artery and a dissecting flap with false lumen, rupture, and hemopericardium. Histologically, there was a zonal medial necrosis with surrounding chronic inflammation, focal destruction of the media, and fibrosis of the intima and adventitia. A diagnosis of granulomatous necrotizing aortitis of Takayasu type was made. This case demonstrates a rare example of aortitis underlying aortic dissection and emphasizes the need for careful histologic examination in cases of aortic root disease.