An Autopsy Case of Myxedema-like Changes in the Media of the Aorta Associated with Chronic Thyroiditis in Postoperative Thoracic Aortic Aneurysm and Lung Perforation

Abstract

A 68-year-old man had a history of open stent graft implantation with left subclavian artery reconstruction for an aortic arch aneurysm. He was undergoing hormone replacement therapy for hypothyroidism. A month after operation, he died of hemorrhagic shock due to hemoptysis and massive hemothorax, and tension pneumothorax. Histopathological examination revealed perforating the remaining aortic aneurysm wall to the lung. Pathological findings showed myxedema-like degeneration of the aortic media. The thyroid gland was found to have chronic thyroiditis (Hashimoto’s disease). Although atherosclerosis changes due to hypercholesterolemia, and myxedema of tissues have been reported in hypothyroidism, it is extremely rare that myxedematous changes in the aortic wall can be confirmed pathologically. Chronic thyroiditis may also present with aortic medial lesions, it is necessary to consider arterial dissection and aneurysm.