A rare case of postmortem diagnosis of penetrating atherosclerotic ulcer rupture in the ascending aorta

A 74-year-old man underwent both a mitral valve replacement and ascending aorta replacement because of the presence of a critical aneurysm. Postoperatory CT angiography revealed both a periprosthetic hematoma of about 40 mm located at the distal prosthetic graft and a modest effusion at the base of the pericardium. 12 days after the surgery the patient suddenly died. Autopsy showed a cardiac tamponade due to ascending aorta rupture secondary to penetrating atherosclerotic ulcer (PAU). This paper highlights the key gross and microscopic findings of this rare lesion, emphasizing its forensic pathology relevance.