ABSTRACT
As part of a review of substance abuse deaths in Dutchess County, New York, the Dutchess County Medical Examiner's Office identified 3 cases of angiocentric systemic foreign-body granulomatosis discovered at autopsy. Our investigation disclosed that in all 3 cases patients surreptitiously injected crushed oral prescription medication. Of the patients, 2 obtained intravenous access through central venous lines, the other patient was found to have injected herself intramuscularly. Autopsy demonstrated lung abnormalities due to diffuse deposits of foreign material within and around vessels, associated with foreign-body granulomatous reaction. We also identified a systemic distribution of this foreign material deposited beyond the lungs in the brain, heart, kidneys, and spleen. We present these cases along with a review of the literature of systemic embolization of foreign material in previously documented cases of deaths due to parenteral abuse of oral medications.
Subject(s)
Granuloma, Foreign-Body/pathology , Adult , Brain/pathology , Cellulose , Female , Forensic Pathology , Humans , Injections , Lung/pathology , Male , Povidone , Pulmonary Embolism/pathology , Pulmonary Fibrosis/pathology , Retrospective StudiesABSTRACT
We report a case of sudden death due to a catastrophic spontaneous rupture of a urinary bladder associated with megacolon due to a fecal impaction (fecaloma). The massively distended rectum and sigmoid colon filled the pelvic cavity and pressed up against the posterior aspects of the uterus, vagina, and urinary bladder. This produced bladder outlet obstruction, followed by massive dilatation and rupture of the urinary bladder, bilateral hydronephrosis, and a 3.5 liter collection of urinary fluid within the abdominal cavity. Complications of chronic constipation, fecalomas, and rupture of the urinary bladder are reviewed.
Subject(s)
Fecal Impaction/complications , Fecal Impaction/pathology , Urinary Bladder/injuries , Urinary Bladder/pathology , Acute Kidney Injury/complications , Bacteremia/complications , Female , Forensic Pathology , Humans , Hydronephrosis/etiology , Hydronephrosis/pathology , Megacolon/etiology , Megacolon/pathology , Middle Aged , Rupture, Spontaneous/etiology , Rupture, Spontaneous/pathology , Schizophrenia , Urinary Bladder Neck Obstruction/complications , Urinary Bladder Neck Obstruction/etiologyABSTRACT
We discuss the autopsy findings of three medico-legal cases of sudden death associated with uncommon neuropathologic findings of which the general forensic pathologist may not be familiar. Case 1 was a 43-year-old man who died of a seizure due to malignant melanoma of the temporal lobe associated with neurocutaneous melanosis (NCM). Case 2 was a 57-year-old woman with a history of mental retardation and incoordination because of chronic lead poisoning, who died of a pulmonary thromboembolism due to deep venous thrombosis status post left leg fracture after a fall down a staircase. Autopsy revealed atrophy and gliosis of her cerebellum as a result of childhood lead poisoning. The third patient was a 75-year-old woman who died as a result of acute bacterial leptomeningitis at the cervico-medullary junction with acute inflammation of the connective tissue of her upper cervical spinal column associated with subluxation of her atlantoaxial (AA) joint, also known as Grisel's syndrome.
