Rom J Leg Med (3) 165 - 172 (2009) © 2009 Romanian Society of Legal Medicine ________________________ *) Corresponding author: Associate Professor, Chair of Legal Medicine, University of Medicine and Pharmacy “Carol Davila” 8, E-mail: cgcurca@yahoo.com 1) National Institute of Legal Medicine “Mina Minovici”, Sos. Vitan Birzesti 9, Sector 4, 042122 – Bucharest, Bucharest, Romania 2) Chair of Anatomy and Embryology, University of Medicine and Pharmacy “Carol Davila” 8, Bd. Eroilor Sanitari, RO-76241, Bucharest, Romania, Phone: +40722363705 E-mail: anatomon@gmail.com 165 Coronary fibromuscular dysplasia and sudden death - case report and literature review George Cristian Curca 1* , Nicolae Sarbu 1 , Dan Dermengiu 1 , Silvia Dermengiu 1 , Elisa Martius 1 , Mugurel Rusu 2 , Sorin Hostiuc 1 Received: 15.03.2009/ Accepted in revised form: 10.07.2009 _____________________________________________________________________ Abstract: We present a sudden cardiac death case in a 43 years old male. Death was determined by an association of coronary tree anomalies (generating a chronic hypo perfusion of the posterior and lateral diaphragmatic wall of the left ventricle) and coronary fibromuscular dysplasia (FMD). A review of recent literature revealed that coronary FMD is an extremely rare (or underreported) pathologic entity, only 16 cases being reported. Key words: coronary fibromuscular dysplasia, myocardial infarction, sudden cardiac death ibromuscular dysplasia (FMD) is considered to be a non-atherosclerotic and non- inflammatory disease which affects small-medium caliber vessels by causing a luminal narrowing; usually affected are renal and carotid arteries and only rarely other arterial territories such as are abdominal, iliac and coronary vessels (very rare). We present in this article a case of intimal fibroplasia affecting coronary vessels in a male and also a brief literature review about this particular entity. Case report While playing a foot tennis game with friends, a 43 years old man, suddenly collapsed. An ambulance arrived at the scene ascertained a cardio-respiratory arrest, started resuscitation and transported him to an Emergency Hospital, where resuscitation efforts where continued but with no effects. A forensic autopsy was performed the next day. The relatives did not provide significant information about his previous medical record. The autopsy revealed the presence of scattered sub pleural and sub epicardial pinpoint hemorrhages, liquid blood and visceral blood pooling, moderate cerebral edema. Toxicological investigations from blood and urine were negative. In the pericardial fluid CK- MB was 941 U/L. The dissection of the heart provided more significant details. Gross pathology and heart dissection F