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October 1958

Cystic Medionecrosis with Dissecting Aneurysm of Coronary Arteries

Author Affiliations


From the Mallory Institute of Pathology, Boston City Hospital, Boston, and the Allerton Hospital, Brookline, Mass. Resident in Pathology (Dr. Boschetti) and attending physician (Dr. Levine).

AMA Arch Intern Med. 1958;102(4):562-570. doi:10.1001/archinte.1958.00260210048008

Aortic cystic medionecrosis with extension of a dissecting aneurysm into the coronary arteries is rare, but medionecrosis and dissection of coronary arteries independent of aortic involvement is even more rare.

Since the first reported case of dissecting aneurysm of the left coronary artery with associated changes of cystic medionecrosis was described by Lovitt and Corzine,1 in 1952, no other cases have appeared in the literature. These authors presented a case of a 39-year-old woman who died shortly after an episode of precordial pain occurring 14 days after a normal delivery. At autopsy a dissecting aneurysm was found involving the anterior descending branch of the left coronary artery, with compression and occlusion of the lumen. Histologically, changes of cystic medial degeneration were found in the coronaries, and there was minimal coronary atherosclerosis. Cystic medionecrosis of the aorta was not observed. The dissecting aneurysm evolved rapidly, for the myocardium showed no

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