LYMPHOPLASMACYTIC AORTITIS AND ACUTE AORTIC DISSECTION - AN UNCOMMON ASSOCIATION

A 43-year-old white man with a history of cigarette smoking, hypertens ion, nephrolithiasis, and cervical degenerative arthritis was hospital ized for sudden-onset, severe, substernal, and pleuritic chest pain wi th epigastric radiation. Despite evaluation, the cause remained unclea r and the patient expired on hospital day 5. Autopsy revealed acute St anford type A aortic dissection, hemopericardium, and hemothorax. Gros sly, the aorta and its branches, including uninvolved medium-sized art eries, displayed extreme mural fragility. Microscopic examination show ed a primary lymphoplasmacytic aortitis-periaortitis without giant cel ls. Rents within the tunica media, medial-adventitial inflammation, an d elastic fiber disruption were limited to sites of gross aortic disse ction. Muscular arteries showed patchy, chronic arteritis-periarteriti s without giant cell infiltrate or aneurysm formation. This case docum ents an unusual association of primary lymphoplasmacytic aortitis and aortic dissection.