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SPONTANEOUS RUPTURE OF SYPHILITIC SACCULAR ANEURYSMS OF THE ASCENDING AORTA INTO THE PERICARDIAL CAVITY, WITH HEMOPERICARDIUM:  Report of Sudden Death in Twenty-Nine Cases

PHILIP GOLDSTEIN, M.D.
Arch Intern Med (Chic). 1949;84(4):540-557. doi:10.1001/archinte.1949.00230040019003.
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THIS REPORT deals with sudden and unexpected natural death in 29 cases in which the cause of death was spontaneous rupture of a saccular aneurysm of the intrapericardial portion of the ascending aorta into the pericardial cavity, with resultant hemopericardium and cardiac tamponade.

The pathologist, in performing an autopsy, attempts to determine the cause of death. One of the least difficult diagnoses is that of a large hemorrhage into the pericardial cavity. If the pericardium is healthy, the hemorrhage may occur in various ways: (a) from spontaneous rupture of the heart wall, from chronic cardiac aneurysm or from necrosis of the myocardium after occlusion of a coronary artery; (b) from rupture of a dissecting aneurysm of the aorta into the pericardial cavity; (c) from an aneurysm of the otherwise normal coronary artery or of the pulmonary artery or from rupture of an atheromatous coronary artery; (d) from trauma, such as

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