Death after Bronchoscopic Biopsy of a Pulmonary Artery Aneurysm Mimicking Bronchial Polyp / 대한법의학회지

Pulmonary artery aneurysms (PAAs) are rare, and massive hemoptysis can lead to death if appropriate diagnosis and treatment is not provided. PAAs can be of congenital, acquired, or idiopathic origin, and the clinical symptoms are various. Among all reported cases, one-third of the patients died due to rupture. Optimal treatment or guidelines for PAAs remain uncertain. Herein, we report autopsy findings from a woman with PAA. The patient was taking medication for tuberculosis. On bronchoscopy, a polypoid lesion was found, suspected to be an inflammatory polyp. Biopsy was performed and massive bleeding into the airway occurred. The bleeding could not be controlled by bronchoscopic suction, and cardiac arrest occurred 30 minutes after biopsy; the patient subsequently died. Autopsy revealed a round, calcified PAA in the bronchus of the right middle lobe; the end of the PAA was torn. Hypovolemic signs, including weak postmortem lividity and pallor of the skin and conjunctivae, were observed. Visual inspection and histopathological examination of the right lung revealed tuberculosis and congestion. Cases related PAA are not uncommon, but autopsy cases of death occurring after biopsy of PAA mimicking bronchial polyps are rarely reported.

Spontaneous Hepatic Rupture in a Pregnant Woman with Preeclampsia: An Autopsy Case / 대한법의학회지

Spontaneous hepatic rupture, which is a complication of hypertension in pregnancy, is extremely rare. However, high maternal and perinatal mortality rates are observed. Several factors, namely, age over 30 years, multiparity, severe preeclampsia, or HELLP syndrome (a group of symptoms which include hemolytic anemia, hepatic enzyme increase, and thrombocytopenia), are associated with this condition. An autopsy case of a woman with twin pregnancy was studied. She was at 36 weeks of gestational age and suffered from the sudden development and rapid progression of hypertension. Moreover, she died because of spontaneous hepatic rupture despite an emergency operation. Autopsy revealed a capsular rupture of the right lobe of the liver with numerous blood clots and hypovolemic signs, such as weak postmortem lividity and palor of the skin and conjunctiva. A close examination of the trunk and liver for the classification of the cause of rupture and an assessment of medical history, such as preeclampsia, are needed during postmortem examination of pregnant women with hepatic rupture or her fetus. To the best of our knowledge, this fatal complication in pregnant women is not yet presented in postmortem examinations in Korea. Thus, we report the findings of this case to share the knowledge.

A Historical Review of the Korean Journal of Legal Medicine: In Commemoration of the 40th Anniversary of the Founding Korean Society for Legal Medicine / 대한법의학회지

The Korean Society for Legal Medicine (KSLM) was founded in 1976 and launched its official journal, the Korean Journal of Legal Medicine (KJLM), in 1977. They have played an important role in Korea's forensic medicine and science, the demand for which has increased in Korean society over the years. A historical review is important and has a significant value in the advancement of forensic medicine and science in Korea. Accordingly, this study reviews and analyzes all papers published in KJLM for 39 years, from Volume 1, Issue No. 1 in 1977 to Volume 39, Issue No. 4 in 2015. There are 891 published papers, which are categorized into 318 review articles, 339 original articles, and 234 case reports. Of the total 891 papers, 377 (42.3%) are related to forensic pathology, whereas 111 (12.5%) concern forensic genetics. The major submitting institutes are forensic medicine departments of universities and the National Forensic Service. KJLM's history can be divided into two phases. The first phase is from the 1970s to the 1990s, and the second, from the 2000s to the present. Many review articles were published in the first phase; approximately 10% of these articles concern clinical forensic medicine and law. Articles on forensic genetics, identification, and entomology also started to be published in the first phase. In the next phase, many case reports from the National Forensic Service were published, and the number of articles on forensic pathology and forensic genetics multiplied. The results of this study provide KSLM and KJLM with direction toward sustainable development. This study is part of the organization's 40th anniversary celebration, and in commemoration of its contribution to advancing human rights and social stability in Korea.

Discrepancies in the Cause and Manner of Death Reported in Postmortem Inspection and Autopsy / 대한법의학회지

Currently in the Republic of Korea, most postmortem investigations occur within the context of a death scene investigation and are restricted to a postmortem inspection without a subsequent autopsy. In this study, we analyzed the discrepancies between the results of postmortem inspection and autopsy to investigate the limits of postmortem inspection. The conclusions about the cause and manner of death stated in the two reports were compared. A retrospective study was carried out on 6,126 autopsy cases performed in the Republic of Korea in 2015. Of these autopsy cases, 2,263 included postmortem inspection reports. The stated cause and manner of death conflicted with the autopsy report in 55.1% and 32.9% of the postmortem inspection reports, respectively. Among these conflicted reports, the cause and manner of death was undetermined in 66.6% and 70.3% of the postmortem inspection reports, respectively. Furthermore, different types of discrepancies were found between the causes and manner of death that were stated in the reports by police investigators and those by forensic pathologists. This study revealed that postmortem inspection is not sufficient in the postmortem investigation and forensic autopsies need to be performed.

The Discrepancy of the Cause and Manner of Death between Death Certificates and Autopsy Reports / 대한법의학회지

Both death certificates and postmortem examination certificates are used as proof of death. These certificates sometimes contain erroneous information but how frequently they do so is unknown. In particular, only a few studies have measured the accuracy of the cause and manner of death on Korea death documents. In this study, we compared the cause and manner of death on both kinds of certificates with those on autopsy reports to determine the frequency of errors, and to identify way to improve the accuracy of these certificates. In 2012, 528 autopsies were requested of out institute, and certificates were submitted in 241 of the cases. The manner of death was classified as natural, unnatural, or unknown. The cause of death in the autopsy report matched that on the death certificate in 37 of 63 cases (58.7%), and the manner of death matched in 40 of 63 cases (63.5%). The cause of death in the autopsy report matched that on the postmortem examination certificate in 62 of 178 cases (34.8%), and the manner of death matched in 74 of 178 cases (41.6%). Death certificates and postmortem examination certificates are important documents. We identified many incorrect reports of causes and manners of death on both kinds of documents, especially the postmortem death certificates. These inaccuracies are presumably due to a lack of forensic information and education, as well as lack of interest on the part of medical doctors.