Primary pulmonary arteries atherosclerosis: discovering an unusual cause of death in forensic practice

Background: In the literature, there are few studies on atherosclerosis in the pulmonary artery in human beings and no cases similar to the one presented has been reported until now. The aim of the study is to describe a particularly unusual case of primary severe pulmonary atherosclerosis, in a 40-year old man, reporting its pathological aspects associated with interstitial lung disease as a cause of a mild pulmonary fibrosis. Case presentation: The patient had marked atherosclerosis in the pulmonary trunk and its branches, probably caused by a series of hemodynamic and endothelial changes, subsequent to the pulmonary hypertension. An autopsy was performed a few days after death in order to explain the reasons of the sudden death. Despite the typical pattern of pulmonary atherosclerosis is generally associated with many co-morbidities, we have found only a significant right ventricular hypertrophy. A complete forensic approach led to attribute the cause of death to cardiorespiratory failure due to severe pulmonary atherosclerosis. Conclusion: in the light of the limited number of reports in the literature, this paper seeks to widen knowledge in the area of atherosclerosis in the pulmonary artery.