Pathology Image of the Month: Mitral Stenosis at Autopsy.

A 52-year-old woman decedent was presented to the hospital autopsy service for a coroner authorized complete autopsy following an admit urine toxicology screen that was positive for cannabinoids. Prior to admission, she was found unresponsive at home after a two month history of increasingly progressive shortness of breath. She was transported to the emergency department and resuscitated after prolonged arrest. She was then admitted to the intensive care unit and subsequently was documented to have significant anoxic brain injury. Care was withdrawn by the family and death was declared on hospital day five. Medical history was reported for type 2 diabetes mellitus, and bipolar schizoaffective disorder with multiple prior psychiatric admissions. Her medical record review revealed a transthoracic echocardiogram two months prior to admission that documented mild mitralregurgitation, moderate mitral valve stenosis and a thickened valvular and subvalvular mitral apparatus with restricted motion of the posterior leaflet. Left atrial enlargement was marked, left ventricular hypertrophy was moderate, and pulmonary hypertension was graded as severe. The ejection fraction was estimated at 70 percent. She was discharged with outpatient follow-up to the cardiology department but was noncompliant with recommendations.

Pathology Image of the Month: Prolonged Fever in a Traveler.

A 23 year old Russian male cargo ship crew member arrived in the port of New Orleans after a one month voyage originating in central Africa. During the month at sea, he developed fever up to 103 degrees Fahrenheit which was unsuccessfully managed with the antipyretic, dipyrone. He subsequently developed back and stomach pain, along with diarrhea. Upon the ship's arrival to New Orleans, he was transported to a local hospital where his axillary temperature was 104 degrees Fahrenheit. He was unresponsive, tachycardic and tachypneic with a plasma bicarbonate of 16mmol/L (24-32mmol/L).