RESUMEN
One of the most frustrating challenges faced by the forensic pathologist is the inability to determine the cause of death in a young person previously thought healthy. The four steps in the investigation of a sudden death include obtaining the history and scene information, performing a gross and microscopic autopsy, performing appropriate laboratory tests, and making the diagnosis. When examining the heart grossly it is important to preserve the anatomic landmarks, section the coronary arteries closely, and recognize lethal abnormalities such as anomalous origin of the coronary arteries. Specimens useful for toxicologic analysis include whole blood, serum, vitreous humor, gastric contents, bile, urine a purple top tube of blood, and frozen myocardium and spleen. Lethal cardiac diseases with minimal or no anatomic findings include Brugada and Garg's syndromes, the long QT syndrome, and Wolff-Parkinson-White (WPW) syndrome. Consultation with other experts, including cardiac pathologists, cardiologists, electrophysiologists, and molecular biologists, may be helpful in determining a cause of death.
Asunto(s)
Muerte Súbita Cardíaca/patología , Autopsia , Técnicas de Laboratorio Clínico , Diagnóstico Diferencial , Humanos , Registros MédicosRESUMEN
It has been known for years that mixing household cleaning products can be hazardous. Nonetheless, from time to time, episodes of pneumonitis from such mixing occur. Although symptoms range from minor upper respiratory irritation to adult respiratory distress syndrome, deaths are very rare. We present the case of a woman with an undiagnosed oligodendroglioma who mixed bleach and ammonia (resulting in the formation of chloramine gas), and died while cleaning her bathroom. To our knowledge, this is the first such death reported from chloramine gas intoxication.
Asunto(s)
Cloraminas/envenenamiento , Adulto , Amoníaco , Combinación de Medicamentos , Resultado Fatal , Femenino , Medicina Legal , Humanos , Oligodendroglioma/patología , Hipoclorito de SodioRESUMEN
A 27-year-old white woman with a history of multiple sclerosis was found dead lying on a lounger, clad in a bathing suit. She had been sunbathing for 4 hours. Significant autopsy findings consisted of numerous variably sized demyelinated plaques involving the periventricular cerebral white matter and cerebellum. Elevation of core temperature in patients with multiple sclerosis leading to transient or permanent adverse neurologic signs and symptoms has been documented for more than 60 years. This case illustrates that a modestly increased core body temperature, even from a usually innocuous activity such as sunbathing, may be fatal in patients with multiple sclerosis.
Asunto(s)
Fiebre/etiología , Helioterapia/efectos adversos , Calor/efectos adversos , Esclerosis Múltiple/complicaciones , Adulto , Autopsia , Encéfalo/patología , Resultado Fatal , Femenino , Fiebre/patología , Fiebre/fisiopatología , Humanos , Esclerosis Múltiple/patología , Esclerosis Múltiple/fisiopatologíaRESUMEN
Atrioventricular (AV) node tumors are very uncommon primary cardiac tumors located exclusively in the AV nodal region. The nomenclature has been diverse according to different histogenetic theories proposed since the first description in 1911. Histochemical, ultrastructural, and immunohistochemical studies have demonstrated its endodermal origin. Patients with these tumors can develop complete heart block or sudden death, but the tumor can also be an incidental finding at autopsy. We present two accidental deaths cases in which multiple foci of atrioventricular node tumor (Case 1) and an isolated cyst (Case 2) were observed in the atrial septum, sparing the conduction system.
Asunto(s)
Nodo Atrioventricular/patología , Carcinoma in Situ/patología , Quistes/patología , Neoplasias Cardíacas/patología , Adolescente , Adulto , Carcinoma in Situ/química , Quistes/química , Femenino , Atrios Cardíacos/patología , Neoplasias Cardíacas/química , Tabiques Cardíacos/patología , Humanos , Queratinas/análisis , Masculino , Mucina-1/análisisRESUMEN
Ventricular septal defects (VSD) are usually considered non-life-threatening, usually closing spontaneously or causing symptoms of congestive heart failure, which can be surgically treated in time to save the patient's life. Despite the usually benign clinical course of VSD, serious arrhythmias occur in 16-31% of patients. Sudden death accounted for one-third of all deaths in a series of medically managed patients and occurred in 4.2% of patients in a study of VSD and arrhythmias. Cardiac hypertrophy is the common denominator in all cases reported in detail of VSD-associated sudden death. We have encountered four cases of sudden unexpected death from VSD in infants ranging in age from 1 week to 3 and (1/2) months. In each case there was cardiomegaly and in one case there was pulmonary arteriolar medial thickening, with extension of smooth muscle into small intralobular vessels. In half of our cases the attending physician was sued for malpractice. We believe that VSD in infants and young children are potentially life-threatening malformations which warrant careful clinical follow-up.
Asunto(s)
Cardiomegalia/complicaciones , Defectos del Tabique Interventricular/complicaciones , Muerte Súbita del Lactante/etiología , Cardiomegalia/patología , Diagnóstico Diferencial , Resultado Fatal , Femenino , Defectos del Tabique Interventricular/patología , Humanos , Lactante , Recién Nacido , Masculino , Arteria Pulmonar/patología , Muerte Súbita del Lactante/patologíaRESUMEN
We describe a massive fatal posterior myocardial infarct resulting from compression of the right coronary artery by a Teflon pledget granuloma in a patient who had undergone aortic valve replacement six months before death. Other iatrogenic causes of coronary artery occlusion or compression are discussed in this paper. To our knowledge this is the first report of this surgical complication.
Asunto(s)
Válvula Aórtica , Enfermedad Coronaria/etiología , Granuloma de Cuerpo Extraño/etiología , Prótesis Valvulares Cardíacas/efectos adversos , Infarto del Miocardio/etiología , Enfermedad Coronaria/patología , Resultado Fatal , Granuloma de Cuerpo Extraño/patología , Humanos , Masculino , Persona de Mediana Edad , PolitetrafluoroetilenoRESUMEN
In February 1995, a 56-year-old female was taken to the operating room for routine placement of a Hickman catheter. Her internist planned palliative chemotherapy for metastatic breast cancer. Using the Seldinger technique, the right subclavian vein was entered and a Hickman catheter was placed. Shortly after extubation and arrival in the postoperative recovery unit, the patient had respiratory and cardiac arrest. Resuscitative efforts, including chest tube placement and pericardiocentesis, were unsuccessful. Autopsy findings included perforation of the superior vena cava, with extension of the catheter in the pericardial sac and associated effusion. Despite the low reported incidence of perforation during placement of central venous catheters, we recommend confirmation of placement by fluoroscopy and instillation of radiopaque dye because of the high mortality associated with this complication.
Asunto(s)
Taponamiento Cardíaco/etiología , Cateterismo Venoso Central/efectos adversos , Pericardio/lesiones , Vena Cava Superior/lesiones , Heridas Penetrantes/etiología , Resultado Fatal , Femenino , Paro Cardíaco/etiología , Humanos , Persona de Mediana EdadRESUMEN
STUDY OBJECTIVE: To assess the type, rate, and severity of unanticipated complications of CPR (external cardiac compressions and ventilation) in a pediatric population. METHODS: A retrospective review was undertaken of the records from all deceased children ( < 12 years old) who had been given CPR during an 8-year period (1988 through 1995). Patients with historical or physical evidence of preceding trauma were excluded. Clinical and autopsy records were abstracted for patient demographics, clinical findings, duration of CPR, persons administering CPR, and medical examiner summaries. RESULTS: Two hundred eleven children (mean age, 19.0 months) met the inclusion criteria and were entered into the study. The most common cause of cardiac arrest was sudden infant death syndrome (56%), followed by drowning (8%), congenital heart disease (7%), and pneumonia (4%). Mean duration of CPR was 45 minutes (range, 3 to 180 minutes). Fifteen children (7%) had at least one injury as a result of CPR; 7 (3%) had injuries that were considered medically significant. These included retroperitoneal hemorrhage (n = 2), pneumothorax (n = 1), pulmonary hemorrhage (n = 1), epicardial hematoma (n = 1), and gastric perforation (n = 1); in spite of prolonged resuscitation performed with variable degrees of skill, only one patient was noted to have rib fractures. CONCLUSION: Significant iatrogenic injuries are rare in children who receive CPR; they occur in approximately 3% of cases. Recognizing the possibility of a complication may help in the management of children who survive cardiac arrest. Regardless of resuscitation history, abuse should be considered whenever traumatic injuries are encountered.
Asunto(s)
Reanimación Cardiopulmonar/efectos adversos , Servicios Médicos de Urgencia/normas , Paro Cardíaco/terapia , Heridas y Lesiones/etiología , Reanimación Cardiopulmonar/mortalidad , Causas de Muerte , Niño , Preescolar , Femenino , Paro Cardíaco/mortalidad , Humanos , Lactante , Recién Nacido , Masculino , Michigan/epidemiología , Vigilancia de la Población , Estudios Retrospectivos , Heridas y Lesiones/mortalidadRESUMEN
Stercoral ulcers result from severe, prolonged constipation. Stercoral ulcer perforation is a rare event resulting in severe peritonitis and has a very high associated mortality rate. We describe a 78-year-old man with severe constipation associated with stercoral ulcer perforation undiagnosed prior to autopsy.
Asunto(s)
Colon/patología , Heces , Úlcera Péptica Perforada/patología , Anciano , Resultado Fatal , Humanos , MasculinoRESUMEN
We describe unexpected autopsy findings in an elderly woman with myasthenia gravis (MG) who had myocarditis of the working and conducting myocardium and coronary and renal vasculitis. Myasthenia gravis, characterized by autoantibodies to the acetylcholine receptor in the postsynaptic cell membrane, may be associated with other autoimmune disorders. An additional manifestation of autoimmunity is the presence of heart muscle antibodies, which may be the basis for myocarditis, which has been reported in up to 60% of MG patients at autopsy. Although myocarditis of the working myocardium is rather common, conduction system myocarditis and systemic vasculitis have not been previously reported in MG.
RESUMEN
We report six cases of intentionally inflicted cardiac laceration. The victims ranged in age from 9 weeks to 2 1/2 years. Five victims were girls and in five cases the right atrium was lacerated. The left ventricle was lacerated in the other case. In the three cases with a confession, one victim each was struck with a fist, stomped, and kicked. Four patients had rib fractures, with at least two fractures in each case. Cardiac rupture from blunt trauma most commonly results from compression of the heart between the sternum and vertebral column, but may also occur from compression of the abdomen or legs, deceleration, blast injury, puncture of the heart by a fractured rib, and rupture through a resolving contusion. Accidentally acquired cardiac lacerations usually result from motor vehicle accidents or similarly severe forces. In children there are neither well documented cases of cardiac laceration nor of rib fractures from cardiopulmonary resuscitation. Cardiac lacerations, as with other types of severe trauma acquired at home, are almost never accidental.
Asunto(s)
Maltrato a los Niños/diagnóstico , Lesiones Cardíacas/etiología , Homicidio , Heridas no Penetrantes/etiología , Reanimación Cardiopulmonar/efectos adversos , Preescolar , Femenino , Humanos , Lactante , Masculino , Fracturas de las Costillas/etiologíaAsunto(s)
Accidentes de Aviación , Etanol/metabolismo , Cambios Post Mortem , Bacterias/metabolismo , HumanosRESUMEN
Anomalous coronary arteries (ACAs) are a potential cause of myocardial ischemia resulting in arrhythmias, angina, infarction, and sudden death. We analyzed 7857 pediatric autopsy cases from four tertiary centers to gain an overall picture of the range and significance of ACAs within this pediatric autopsy population. The incidence of ACAs was 0.5%, with ectopic origin from the aorta (43%) being most frequent, followed by ACA arising from the pulmonary trunk (40%). The mean age at death was 2.2 years (4 h-14 years). ACAs were associated with other anomalies in 57% of cases, 43% of these being cardiac defects. Growth retardation was noted in 50% of the cases. Examination of the heart showed cardiomegaly in 92% of cases, which was marked (> 95 percentile) in 63%, but histologically apparent ischemic damage was seen in only 50% of cases. ACAs arising from the pulmonary trunk were associated with earlier death (1.4 years), more frequent cardiomegaly (100%), and more frequent myocardial scarring (92%) than other types of anomalies. Although the terminal presentation was sudden death in 45% of cases, ACAs associated with other cardiac defects presented mainly with problems related to the latter anomalies. The results highlight the need to examine coronary arteries carefully during the pediatric autopsy. Not only are the positions of the coronary artery ostia important, but also the variations in the angles of arterial take-off, initial courses through the aortic adventitia, subsequent courses, and presence of ostial ridges or membranes that may result in significant compromise of blood flow.
Asunto(s)
Anomalías de los Vasos Coronarios/patología , Cardiomegalia/etiología , Cardiomegalia/patología , Niño , Preescolar , Enfermedad Coronaria/etiología , Enfermedad Coronaria/patología , Anomalías de los Vasos Coronarios/complicaciones , Anomalías de los Vasos Coronarios/fisiopatología , Muerte Súbita/etiología , Insuficiencia de Crecimiento , Femenino , Cardiopatías Congénitas/complicaciones , Humanos , Lactante , Recién Nacido , Masculino , Estudios RetrospectivosRESUMEN
Hypertrophy of the lingual tonsils is an unusual condition that may cause complications such as airway obstruction, abscess, sleep apnea, and recurrent epiglottitis. There have been reports of difficult anesthesic intubation in children with enlarged lingual tonsils. We describe a 24-year-old woman whose markedly hypertrophied lingual tonsils prevented intubation after anesthesic relaxation during preparation for appendectomy.