Pericardial tear as a consequence of cardiopulmonary resuscitation (CPR) involving chest compression: A report of two postmortem cases of acute type A aortic dissection with hemopericardium

• We reviewed postmortem CT scans and autopsies for fatal cases of acute type A aortic dissection with hemopericardium.
• We found a pericardial tear at the left posterolateral site of the pericardium and a left hemothorax.
• The pericardial tear was a consequence of CPR and intrapericardial blood leaked through the pericardial tear resulting in a hemothorax.
• A stress concentration was exerted on the left pericardial–diaphragmatic junction during CPR, resulting in a pericardial rupture.

We present two cases of a pericardial tear as a consequence of cardiopulmonary resuscitation involving chest compressions in fatal acute type A aortic dissection (AoD) with hemopericardium. For each case, postmortem computed tomography revealed a hematoma in the false lumen of the ascending aorta with a slight hemopericardium and a large left hemothorax, as well as focal pericardial dimpling and discontinuity around the left ventricle. At autopsy, we confirmed a convex lens-shape gaping pericardial tear at the left posterolateral site of the pericardium and a massive volume of bloody fluid in the left thoracic cavity. It has been hypothesized that the pericardium ruptured due to chest compressions during resuscitation in these cases of acute type A AoD with hemopericardium and that intrapericardial blood leakage through the pericardial tear resulted in a hemothorax.