Adenoid Cystic Carcinoma of the Trachea Resulting in Fatal Asphyxia.

Primary malignant tumors of the trachea are uncommon. The authors report a case of a 72-year-old female who died from asphyxia due to an undiagnosed obstructing adenoid cystic carcinoma of the trachea. The decedent became unresponsive while eating cereal and was pronounced upon arrival at the local hospital. The autopsy revealed a near occlusive tumor mass just superior to the bifurcation of the distal trachea. There was no evidence of aspiration. The death was the result of asphyxia due to obstruction of the trachea by an adenoid cystic carcinoma. This case demonstrates that an obstructive tumor mass may remain undiagnosed until an obstructive episode results in a sudden death.

Carbon monoxide poisoning and death in a large enclosed ventilated area.

A 55-year-old man with a medical history of tobacco use suddenly collapsed while power washing an empty indoor pool in a hotel. The decedent was transported to the local hospital where he was pronounced. A postmortem examination revealed atherosclerotic heart disease and bilateral pulmonary edema and congestion. A postmortem blood carbon monoxide (CO) level was 27% saturation, and a CO performed on hospital admission blood was 49% saturation. CO poisoning is a common cause of toxicological morbidity and mortality in the United States. The circumstances most often occur in an enclosed environment and may be intentional or unintentional. CO poisoning has been reported in open, well-ventilated spaces, but rarely results in death. A warning label was present on the engine clearly stating the dangers of CO emission. However, there was a false sense of security due to the large size of the pool room and the presence of industrial blowers that were being used for ventilation.

Death due to eosinophilic necrotizing myocarditis despite steroid treatment.

We report a case of a 16-year-old boy who was treated for a suspected dental infection with a tooth extraction and amoxicillin therapy. The decedent developed a rash and presented to the emergency department with what was thought to be a possible allergic reaction to amoxicillin despite completion of the antibiotic course. The patient was given a course of prednisone. Several weeks later, while still completing the course of prednisone, the patient experienced shortness of breath and collapsed. Resuscitation efforts were unsuccessful. Postmortem examination revealed a necrotizing eosinophilic myocarditis. This case reveals that despite steroid therapy, a patient may still die of eosinophilic myocarditis.

Bladder rupture after intentional medication overdose.

We report the case of a 51-year-old woman who had a medical history of diabetes, depression with past suicide attempts, and suicidal ideation. She was found unresponsive in a motel with multiple bottles of medicines (melatonin, carisoprodol, ativan, and clonazepam) and an unopened bottle of wine. She was transported to the local hospital and treated for benzodiazepine toxicity and aspiration pneumonitis.The decedent gradually became more alert and was extubated 3 days after hospital admission. The decedent was reportedly getting up to use the restroom when she became tachypneic and diaphoretic and complained of generalized body pain. Her condition quickly declined, and she was pronounced deceased. A postmortem examination revealed an acute bladder rupture and soft tissue hemorrhage.A review of the literature reveals that isolated bladder rupture after minimal or no trauma in association with alcohol or drug ingestion is an infrequently reported, but recognized, injury. The diagnosis of bladder rupture should be considered in a patient with lower abdominal pain, even without a history of trauma. A history of voiding or bladder dysfunction should increase the suspicion for this injury. If suspected, a retrograde cystogram should be obtained promptly. Failure to consider and recognize this injury may lead to significant morbidity.