[Unusual histopathological picture of acute lung injury in different stages of resorption with predominance of organizing pneumonia in a young man with influenza A (H1N1)]. / Neobvyklý histopatologický obraz akútneho poskodenia plúc v rôznej fáze rezorpcie s prevahou organizujúcej sa pneumónie u jedinca s chrípkou A(H1N1).

In this case report the authors describe histomorphological findings of acute lung injury with laboratory-confirmed influenza type A(H1N1) pneumonia leading to the death of a 30 year-old unvaccinated man after 27 days of hospitalisation. Histologically all three types of acute lung injuries were unusually present (diffuse alveolar damage, acute interstitial pneumonia, organizing pneumonia) in different phases of resorption and reparation with transition to extensive fibrosis.

Sudden death associated with syndromic craniosynostosis.

In this paper we report the autopsy findings of a 7 year old girl who presented with headache, nausea and repeated vomiting and died unexpectedly at home. She had no previous history of major illnesses and no history of epileptic seizures. External examination revealed ocular abnormalities. Internal examination demonstrated severe cerebral edema with tonsillar herniation, premature fusion of the cranial bone sutures, and prominent convolutional markings of the inner table of the skull. Death was due to severe cerebral edema complicating syndromic craniosynostosis. The craniofacial features in this case were in keeping with a diagnosis of Crouzon syndrome which was confirmed by molecular testing of the FGFR2 gene. Crouzon syndrome is a genetic disorder characterized by premature fusion of the cranial bone sutures resulting in distinctive malformations of the craniofacial region.

Sudden unexpected death due to severe pulmonary and cardiac sarcoidosis.

In this paper we report the autopsy findings of a 57 year old woman who died unexpectedly at home. She had been complaining of shortness of breath, episodes of dry coughing, and nausea. Her past medical and social history was unremarkable. She had no previous history of any viral or bacterial disease and no history of oncological disorders. Autopsy revealed multiple grayish-white nodular lesions in the pleura and epicardial fat and areas resembling fibrosis on the cut surface of the anterior and posterior wall of the left ventricle and interventricular septum. Histological examination of the lungs and heart revealed multiple well-formed noncaseating epithelioid cell granulomas with multinucleated giant cells. Death was attributed to myocardial ischemia due to vasculitis of intramural coronary artery branches associated with sarcoidosis. Sarcoidosis is a multisystemic disease of unknown etiology characterized by the formation of noncaseating epithelioid cell granulomas in the affected organs and tissues. The diagnosis of sarcoidosis in this case was established when other causes of granulomatous disease such as tuberculosis, berylliosis, hypersensitivity pneumonitis, and giant cell myocarditis had been reasonably excluded.

[Non-traumatic arteriovenous malformation of the spleen with fatal hemorrhage]. / Non-traumatická arteriovenózna malformácia sleziny s fatálnym krvácaním.

From the medical point of view, splenic rupture developed either as a result of traumatic injury or as a result of any type of splenic disease represents a very severe and life-threatening condition. We describe the case of a 65-year old man without any obvious traumatic injury who was hospitalised because of left abdominal pain. Investigations performed at admission to the hospital (RTG, USG) failed to indicate any signs of intraabdominal bleeding. However, the patient died suddenly after 24 hours of hospitalisation. At autopsy massive intraabdominal bleeding was found. It was caused by rupture of splenic intraparenchymal hematoma developed as a result of an arteriovenous malformation in the lower pole of the spleen. This case shows the necessity of knowledge of all circumstances of death as well as the necessity of consistent histological investigation of the spleen in such cases.

Unexpected fatal outcome of laparoscopic inguinal hernia repair.

In this paper we report the autopsy findings of a long-term warfarinized 60-year-old man who died unexpectedly 2 days after undergoing laparoscopic transabdominal pre-peritoneal (TAPP) inguinal hernia repair. In his medical records it was stated that the perioperative and postoperative period was uneventful with no sign of bleeding and he was discharged the day after surgery. Autopsy revealed massive bleeding in the pre-peritoneal space at the surgery site and a massive left inguinal canal hematoma spreading through the spermatic cord to the left scrotum. There was no evidence of retroperitoneal bleeding. No sign of traumatic injury to the abdominal wall, major abdominal and pelvic vessels was revealed. The cause of death was hemorrhagic shock. We believe that this is the first documented case of fatal outcome after TAPP inguinal hernia repair in Slovakia. Inguinal hernias account for approximately two-thirds of all abdominal wall hernias. The reported case demonstrates that routine procedures such as TAPP hernia repair can have a fatal outcome, not due to any surgical mishap but because of the altered health status of the patient.

Encephalocystocele - uncommon diagnosis in prenatal medicine.

Encephalocystocele is a developmental malformation characterized by brain herniation accompanied with extracranial cystic protrusion of the ventricular system. This nosological unit is often overlooked and insufficiently classified merely as encephalocele. Herein, two exceptionally clear cases of the parieto-occipital cranioschisis with encephalocystocele and congenital hydrocephalus of the lateral ventricles are documented with 2-dimensional/3-dimensional sonographic images and the corresponding MRI findings. In both cases, prenatal diagnosis was confirmed by autopsy.