Myocarditis in the forensic setting - a review of the literature.

Diagnosis of myocarditis as the cause of death at post-mortem is currently determined by a forensic pathologist. There is no systematic method for diagnosis and thus the determination is subject to inter-observer variability and is non-reproducible. Postmortem studies often rely on the clinical method of diagnosis, which is inaccurate. Furthermore, there is no current standardized method of distinguishing between myocarditis as cause of death, and myocardial inflammation as an incidental finding post-mortem. Only a few studies have investigated a method of quantifying this difference using variables such as number of inflammatory cells and presence of myocyte necrosis, however, there are several limitations hindering the reproducibility of this research. This review investigates the current practices and limitations associated with the diagnosis of myocarditis as cause of death in the autopsy setting.

Myocarditis in the forensic setting.

Diagnosis of myocarditis as the cause of death in the forensic setting at post-mortem is currently determined by a forensic pathologist. There is no systematic method for diagnosis and thus the determination is subject to inter-observer variability and is often non-reproducible. The primary aim of this study was to investigate the differences in the amount of inflammation between cases where myocarditis was deemed the cause of death, compared to cases where myocardial inflammation was incidentally present at autopsy, but not determined to be the cause of death. Participants were sourced from the Victorian Institute of Forensic Medicine (VIFM) database, from full autopsies conducted on reportable death in Victoria, Australia between the years 2011 and 2021. Cases of fatal myocarditis were significantly more likely to experience infection-like symptoms prior to death, and to be in hospital at the time of death. Histopathological examination revealed fatal cases had a significantly higher inflammatory index compared to the incidental group. Lethal cases were also significantly more likely to have myocyte necrosis, and a diffuse pattern of inflammation. There are significant differences between cases where myocardial inflammation has been determined to be the cause of death and cases where inflammation in the myocardium was an incidental finding. These results could be used in the forensic autopsy to help pathologists determine if inflammation should be considered fatal or incidental.