ABSTRACT
Introducción y objetivos: La disección de la aorta torácica (DAT) es infrecuente en jóvenes y presenta características diferentes que en la población adulta. En este estudio se analizan las características clinicopatológicas de la muerte súbita por DAT de personas de 1-35 años. Métodos: Estudio poblacional multicéntrico basado en autopsias forenses realizadas en las provincias de Vizcaya (periodo 1991-2016), Valencia (2000-2016) y Sevilla (2004-2016). Resultados: Se recogieron 35 casos (el 80% varones), con una media de edad de 29+/-5 años. La incidencia fue de 0,09/100.000 habitantes/año; 18 sujetos tenían algún factor de riesgo y 29, 1 o más factores de riesgo o hallazgos post mortem asociados con DAT: cardiopatía congénita (n=16), sospecha de DAT familiar (n=11), consumo de cocaína (n=6) e hipertensión arterial (n=5). En 24 casos, 12 con algún factor de riesgo, ya habían presentado síntomas previamente; 16 acudieron al médico, pero nunca hubo sospecha de DAT. El dolor torácico (n=12) fue el síntoma más frecuente. Los hallazgos autópsicos principales fueron: degeneración quística de la media (n=27), dilatación de la aorta ascendente (n=21), cardiomegalia (n=20) y válvula aórtica bicúspide (n=14). Conclusiones: La incidencia de muerte súbita por DAT fue muy baja. Los factores de riesgo más frecuentes fueron las cardiopatías congénitas, seguidas de la sospecha de DAT familiar y el consumo de cocaína. Se debería incluir la DAT en el diagnóstico diferencial del dolor torácico en jóvenes, principalmente varones, con factores de riesgo asociados
Introduction and objectives: Thoracic aortic dissection (TAD) is infrequent in young people and its characteristics differ from those in the adult population. This study aimed to analyze the clinical and pathological characteristics of sudden death due to TAD in people aged 1 to 35 years. Methods: Multicenter population-based study based on forensic autopsies conducted in the provinces of Biscay (1991-2016), Valencia (2000-2016), and Seville (2004-2016). Results: We identified 35 individuals with sudden death due to TAD (80% males), with a mean age of 29+/-5 years. The incidence was 0.09/100 000 inhabitants/y. Eighteen persons had at least 1 risk factor for TAD, and this figure increased to 29 when postmortem findings were included: congenital heart disease (n=16), suspicion of familial TAD (n=11), cocaine use (n=6), and hypertension (n=5). Twenty-four individuals, 12 with at least 1 risk factor, had prodromal symptoms, and 16 of them visited their physician, but TAD was not suspected in any of them. The most frequent symptom was chest pain (n=12). The main autopsy findings were cystic degeneration of the media (n=27), dilatation of the ascending aorta (n=21), cardiac hypertrophy (n=20), and bicuspid aortic valve (n=14). Conclusions: The incidence of sudden death due to TAD in young people was very low. The most frequent risk factors were congenital heart disease followed by suspicion of familial TAD and cocaine use. TAD should be included in the differential diagnosis of chest pain in young people, mainly male patients with at least 1 risk factor
Subject(s)
Humans , Male , Female , Young Adult , Adult , Aortic Dissection/mortality , Death, Sudden, Cardiac/epidemiology , Aortic Aneurysm/mortality , Autopsy/statistics & numerical data , Diagnosis, Differential , Chest Pain/etiology , Forensic Pathology/methodsABSTRACT
INTRODUCTION AND OBJECTIVES: Thoracic aortic dissection (TAD) is infrequent in young people and its characteristics differ from those in the adult population. This study aimed to analyze the clinical and pathological characteristics of sudden death due to TAD in people aged 1 to 35 years. METHODS: Multicenter population-based study based on forensic autopsies conducted in the provinces of Biscay (1991-2016), Valencia (2000-2016), and Seville (2004-2016). RESULTS: We identified 35 individuals with sudden death due to TAD (80% males), with a mean age of 29±5 years. The incidence was 0.09/100 000 inhabitants/y. Eighteen persons had at least 1 risk factor for TAD, and this figure increased to 29 when postmortem findings were included: congenital heart disease (n=16), suspicion of familial TAD (n=11), cocaine use (n=6), and hypertension (n=5). Twenty-four individuals, 12 with at least 1 risk factor, had prodromal symptoms, and 16 of them visited their physician, but TAD was not suspected in any of them. The most frequent symptom was chest pain (n=12). The main autopsy findings were cystic degeneration of the media (n=27), dilatation of the ascending aorta (n=21), cardiac hypertrophy (n=20), and bicuspid aortic valve (n=14). CONCLUSIONS: The incidence of sudden death due to TAD in young people was very low. The most frequent risk factors were congenital heart disease followed by suspicion of familial TAD and cocaine use. TAD should be included in the differential diagnosis of chest pain in young people, mainly male patients with at least 1 risk factor.
Subject(s)
Aorta/pathology , Aortic Aneurysm, Thoracic/complications , Aortic Dissection/complications , Death, Sudden/epidemiology , Adolescent , Adult , Aortic Dissection/diagnosis , Aortic Aneurysm, Thoracic/diagnosis , Autopsy , Child , Child, Preschool , Death, Sudden/etiology , Death, Sudden/pathology , Female , Humans , Incidence , Infant , Male , Spain , Young AdultABSTRACT
El estudio del corazón es esencial en la investigación de un gran número de autopsias judiciales, especialmente en los casos de muerte súbita cardiaca. Un estudio óptimo requiere un examen macroscópico y microscópico protocolizado. El objetivo de este artículo es presentar unos conceptos básicos sobre el procedimiento de estudio del corazón, con el fin que los médicos forenses estén familiarizados con el mismo(AU)
The study of the heart is essential in the investigation of a large number of forensic autopsies, especially in cases of sudden cardiac death. An optimal study requires a protocolized macroscopic and microscopic examination. The aim of this article is to present some basic concepts about the procedure for examining the heart, thus ensuring the forensic physicians are familiar with it(AU)
Subject(s)
Humans , Male , Female , Forensic Medicine/methods , Forensic Pathology/legislation & jurisprudence , Autopsy/ethics , Autopsy/methods , Death, Sudden/epidemiology , Death, Sudden/pathology , Heart Defects, Congenital/diagnosis , Heart Defects, Congenital/genetics , Heart Diseases/epidemiology , Forensic Pathology/organization & administration , Forensic Pathology/standards , Autopsy/instrumentation , AutopsyABSTRACT
La laceración hepática es una complicación poco frecuente de la resucitación cardiopulmonar.La reanimación cardiopulmonar puede originar lesiones de vísceras abdominales.Las complicaciones del masaje cardiaco externo, en especial referencia a las lesiones hepáticas,son escasamente descritas. Es importante usar una técnica correcta con el fin deevitar lesiones en órganos próximos. A pesar de que la laceración hepática es rara los serviciosmédicos deben estar alerta de dicha complicación. Describimos un caso de laceraciónhepática descubierta en el estudio post morten. [Emergencias 2009;21:148-150](AU)
Laceration of the liver is a rare complication of cardiopulmonary resuscitation, which can damage nearby abdominalorgans. Complications of external cardiac massage, particularly those affecting the liver, are rarely reported, however. Itis important to apply the correct techniques in order to avoid damaging nearby organs; although liver laceration is a rarecomplication, emergency physicians should be aware that it might occur. We describe a case of liver lacerationdiscovered during autopsy. [Emergencias 2009;21:148-150](AU)
Subject(s)
Humans , Male , Middle Aged , Cardiopulmonary Resuscitation/adverse effects , Liver/injuries , Lacerations/etiology , Fatal OutcomeABSTRACT
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