RESUMO
ABSTRACT: When a young previously healthy person dies suddenly, occasionally, the scene is noncontributory and the autopsy and drug screen are negative. In such cases, additional studies, including genetic assessment and cardiac conduction system examination, should be performed. We performed a literature search and reviewed our own material to identify possible or definite conduction system anomalies that may cause death. We identified intrinsic conduction system disease including cystic tumor of the atrioventricular node, atrioventricular node (cystic tumor of the AV node), and fibromuscular dysplasia of the atrioventricular node artery to be likely causes of death. Extrinsic causes, in which a generalized disease affects the conduction system, include tumors, autoimmune disease, infiltrative disorders, and others, are a second category of diseases that can affect the conduction system and cause atrioventricular block and sudden death.
Assuntos
Displasia Fibromuscular , Neoplasias , Humanos , Sistema de Condução Cardíaco/patologia , Morte Súbita/etiologia , Nó Atrioventricular/patologia , Displasia Fibromuscular/patologia , Neoplasias/complicações , Neoplasias/patologia , Morte Súbita Cardíaca/etiologia , Morte Súbita Cardíaca/patologiaRESUMO
OBJECTIVES: Pathophysiology of function tricuspid regurgitation (FTR) is incompletely understood. We set out to comprehensively evaluate geometric and tissue remodelling of the tricuspid valve complex in ovine FTR. METHODS: Twenty adult sheep underwent left thoracotomy and pulmonary artery banding (PAB) to induce right heart pressure overload and FTR. After 8 weeks, 17 surviving animals and 10 healthy controls (CTL) underwent sternotomy, echocardiography and implantation of sonomicrometry crystals on right ventricle and tricuspid valvular apparatus. Haemodynamic and sonomicrometry data were acquired in all animals after weaning from cardiopulmonary bypass. Leaflet tissue was harvested for pentachrome histologic analysis and biomechanical testing. RESULTS: Animal weight was 62 ± 5 and 63 ± 3 kg for CTL and PAB, respectively (P = 0.6). At terminal procedure, systolic pulmonary artery pressure was 22 ± 3 and 40 ± 7 mmHg for CTL and PAB, respectively (P = 0.0001). The mean TR grade (+0-4) was 0.8 ± 0.4 and 3.2 ± 1.2 (P = 0.0001) for control and banded animals, respectively. Right ventricle volume (126 ± 13 vs 172 ± 34 ml, P = 0.0019), tricuspid annular area (651 ± 109 vs 865 ± 247 mm2, P = 0.037) and area between papillary muscle tips (162 ± 51 vs 302 ± 75 mm2, P = 0.001) increased substantially while systolic excursion of anterior leaflet decreased significantly (23.8 ± 6.1° vs 7.4 ± 4.5°, P = 0.001) with banding. Total leaflet surface area increased from 806 ± 94 to 953 ± 148 mm2 (P = 0.009), and leaflets became thicker and stiffer. CONCLUSIONS: Detailed analysis of the tricuspid valve complex revealed significant ventricular, annular, subvalvular and leaflet remodelling to be associated with ovine functional tricuspid regurgitation. Durable surgical repair of severe FTR may require a multi-level approach to the valvular apparatus.
Assuntos
Insuficiência da Valva Tricúspide , Ovinos , Animais , Insuficiência da Valva Tricúspide/cirurgia , Valva Tricúspide/diagnóstico por imagem , Valva Tricúspide/cirurgia , Ecocardiografia , Ventrículos do Coração , CatéteresRESUMO
ABSTRACT: Volatile chemicals can be relevant in the determination of the cause and manner of death by forensic pathologists. Isopropanol is a secondary alcohol that is occasionally seen on postmortem toxicology testing. A series of 11 forensic autopsy cases was previously reported in which the presence of isopropanol in the vitreous humor was suspected to be due to postmortem contamination from the body preparation process for tissue procurement.In collaboration with a tissue procurement agency, donor vitreous humor was collected from one eye before body preparation for procurement and from the other eye postpreparation. The specimens underwent testing for volatile substances by headspace gas chromatography.Of the 50 cases, 8 (16%) showed statistically significant changes in the prepreparation and postpreparation isopropanol concentrations. Postpreparation isopropanol concentrations ranged from 5 to 104 mg/dL (median, 18 mg/dL). Seven of the 8 cases had undetectable prepreparation isopropanol, whereas the remaining case had a detectable prepreparation isopropanol.In conclusion, surface contamination of the decedent's body with chemicals used in body preparation can lead to the passive absorption into the body, resulting in the presence of isopropanol in postmortem toxicology samples. Forensic pathologists need to be aware of this when interpreting postmortem samples after tissue procurement.
Assuntos
Líquidos Corporais , Obtenção de Tecidos e Órgãos , Humanos , Autopsia , 2-Propanol/análise , Etanol/análise , Líquidos Corporais/química , Mudanças Depois da MorteRESUMO
We discuss the pathophysiology and epidemiology of Toxocara catis infection complicated by visceral larval migrans . We describe a previously healthy 19-month-old white male child found dead in bed by his mother. He had what was thought to be an upper respiratory infection for several days.The child had eosinophilic hepatitis and myocarditis complicating visceral larval migrans due to Toxocara catis infection from the family cat. We discuss the pathologic and clinical aspects of visceral larval migrans due to of Toxocara catis infection.
Assuntos
Miocardite , Toxocaríase , Masculino , Animais , Gatos , Toxocaríase/complicações , Toxocara , FígadoRESUMO
Sudden cardiac death is, by definition, an unexpected, untimely death caused by a cardiac condition in a person with known or unknown heart disease. This major international public health problem accounts for approximately 15-20% of all deaths. Typically more common in older adults with acquired heart disease, SCD also can occur in the young where the cause is more likely to be a genetically transmitted process. As these inherited disease processes can affect multiple family members, it is critical that these deaths are appropriately and thoroughly investigated. Across the United States, SCD cases in those less than 40 years of age will often fall under medical examiner/coroner jurisdiction resulting in scene investigation, review of available medical records and a complete autopsy including toxicological and histological studies. To date, there have not been consistent or uniform guidelines for cardiac examination in these cases. In addition, many medical examiner/coroner offices are understaffed and/or underfunded, both of which may hamper specialized examinations or studies (e.g., molecular testing). Use of such guidelines by pathologists in cases of SCD in decedents aged 1-39 years of age could result in life-saving medical intervention for other family members. These recommendations also may provide support for underfunded offices to argue for the significance of this specialized testing. As cardiac examinations in the setting of SCD in the young fall under ME/C jurisdiction, this consensus paper has been developed with members of the Society of Cardiovascular Pathology working with cardiovascular pathology-trained, practicing forensic pathologists.
Assuntos
Cardiopatias , Patologistas , Humanos , Idoso , Adulto , Lactente , Pré-Escolar , Criança , Adolescente , Adulto Jovem , Morte Súbita Cardíaca/etiologia , Morte Súbita Cardíaca/patologia , Cardiopatias/complicações , Autopsia/métodos , CoraçãoRESUMO
Soot is deposited from 20-30 cm from the muzzle of most handguns and arranged concentrically around the entry wound. We examined a case of a self-inflicted gunshot wound from a 9-mm pistol that left an unusual pattern of soot deposition consisting of two circular 3-mm deposits of soot located 2 cm from the entry wound. Examination of the weapon and test-firing it against a cloth reproduced the soot deposits, which were caused by two ports on the top of the barrel. Examination of the weapon and comparing the barrel with the entry wound and surrounding skin may provide important information about the type of weapon, the muzzle-to-target distance, and atypical soot deposits.
Assuntos
Armas de Fogo , Ferimentos por Arma de Fogo , Balística Forense , Humanos , Fuligem , Ideação SuicidaRESUMO
CASE PRESENTATION: A 40-year-old woman presented with recurrent syncope. She reported multiple (>20) episodes of non-prodromal loss of consciousness, periodically provoked by physical exertion. One episode resulted in a nasal fracture due to the abrupt nature of her syncope. The characterization of each episode was inconsistent with a neurogenic seizure. Other causes of syncope (vasovagal, situational, carotid hypersensitivity, and orthostasis) were also deemed unlikely. On physical examination, a low-pitched, brief adventitious sound was appreciated after each S2 sound in the right lower sternal border. The remainder of the physical examination was unremarkable. Initial workup, including complete blood count, comprehensive metabolic panel, cardiac enzymes, and ECG yielded normal results. The chest radiograph did not show any gross cardiac or pulmonary parenchymal pathologic condition (Fig 1). Telemetry did not demonstrate any malignant arrhythmias, and video-guided EEG did not document any seizure activity.
Assuntos
Coristoma , Dissecação/métodos , Eletrocardiografia/métodos , Átrios do Coração/diagnóstico por imagem , Cardiopatias , Fígado , Síncope , Adulto , Coristoma/diagnóstico por imagem , Coristoma/fisiopatologia , Coristoma/cirurgia , Diagnóstico Diferencial , Eletroencefalografia/métodos , Feminino , Cardiopatias/diagnóstico , Cardiopatias/fisiopatologia , Cardiopatias/cirurgia , Humanos , Exame Físico/métodos , Recidiva , Síncope/diagnóstico , Síncope/etiologia , Síncope/fisiopatologia , Resultado do Tratamento , Veia Cava Inferior/diagnóstico por imagemRESUMO
We report the sudden unexpected death from exsanguination of a 60-year-old white female who underwent balloon angioplasty of her right popliteal artery via a right common femoral arteriotomy 3 weeks before death. This resulted in a mycotic pseudoaneurysm of the right femoral artery that ruptured, causing fatal exsanguination. A pseudoaneurysm is an arterial wall defect in which part of the wall consists of fibrin and fibrous tissue, lacking components of the normal arterial wall, that is intima, media, and adventitia. Pseudoaneurysms result from traumatic arterial injury, infection, rupture of a true aneurysm, or surgery. A literature search revealed no reports with the patient dying unexpectedly outside the hospital. Immediate surgical intervention and antibiotic therapy are preferred treatments.
Assuntos
Falso Aneurisma/etiologia , Aneurisma Infectado/etiologia , Aneurisma Roto/etiologia , Angioplastia com Balão/efeitos adversos , Artéria Femoral/lesões , Lesões do Sistema Vascular/etiologia , Falso Aneurisma/patologia , Aneurisma Infectado/patologia , Aneurisma Roto/patologia , Autopsia , Evolução Fatal , Feminino , Artéria Femoral/patologia , Humanos , Pessoa de Meia-Idade , Resultado do Tratamento , Lesões do Sistema Vascular/patologiaRESUMO
Determining the correct cause and manner of death are among the chief responsibilities of the forensic pathologist. When confronted with a case having a questionable manner of death, it is important for scene evidence, witness statements, and forensic autopsy findings to be thoroughly reviewed before certifying the manner of death. Herein three gunshot wound cases are presented which initially were suspected to be suicides but were instead determined to be homicides through full investigations with correlation to autopsy findings.
Assuntos
Acidentes de Trânsito/mortalidade , Dispositivos de Proteção da Cabeça , Motocicletas/legislação & jurisprudência , Adulto , Autopsia , Lesões Encefálicas Traumáticas/etiologia , Lesões Encefálicas Traumáticas/mortalidade , Causas de Morte , Feminino , Humanos , Masculino , Programas Obrigatórios/legislação & jurisprudência , Michigan/epidemiologiaRESUMO
Cystic tumour of the atrioventricular node is the smallest tumour that can cause sudden cardiac death. This lesion arises from foregut endodermal rests which become enfolded into the heart during embryogenesis. Typically causing heart block, the tumour can cause sudden death despite pacemaker placement. Sudden death in such cases can be caused by arrhythmogenic ectopic foci arising from impaired electrical impulse propagation through the abnormal atrioventricular junction conducting tissue.
RESUMO
We describe an 8-year-old white boy with a history of fetal alcohol syndrome and pica, who was found dead on the floor by his mother. The child died from massive intestinal dilatation causing asphyxia. We discuss the potential pathogenetic mechanisms of intestinal dilation in patients with fetal alcohol syndrome.
Assuntos
Asfixia/etiologia , Transtornos do Espectro Alcoólico Fetal , Obstrução Intestinal/patologia , Pica/patologia , Criança , Corpos Estranhos/patologia , Humanos , Obstrução Intestinal/etiologia , Masculino , Pica/complicaçõesRESUMO
BACKGROUND: Immediately fatal motorcycle crashes have not been well characterized. This study catalogues injuries sustained in fatal motorcycle crashes and assesses the impact of crash conditions on injury patterns. METHODS: Autopsy records from the office of the medical examiner of Kent County, MI and publicly available traffic reports were queried for information pertaining to motorcyclists declared dead on-scene between January 1, 2007, and December 31, 2016. RESULTS: A total of 71 autopsies of on-scene motorcycle crash fatalities were identified. The two most prevalent injuries were traumatic brain injury (TBI) (85%) and rib fractures (79%). The majority of fatalities occurred in daylight hours (54.3%) and in a 55 mph speed limit zone (63.8%). CONCLUSIONS: This study provides a catalogue of the injuries sustained in immediately fatal motorcycle crashes and the associated conditions. Advocacy efforts that highlight the risks associated with motorcycle riding and that promote safe riding practices are warranted.
Assuntos
Acidentes de Trânsito/mortalidade , Motocicletas , Ferimentos e Lesões/mortalidade , Adulto , Causas de Morte , Feminino , Dispositivos de Proteção da Cabeça/estatística & dados numéricos , Humanos , Masculino , Michigan/epidemiologia , Pessoa de Meia-Idade , PrevalênciaRESUMO
We describe a 24-year-old man with a cystic hygroma of the left side of the lower neck that led to sudden death. Cystic hygroma (cystic lymphangioma) is a congenital malformation of the lymphatic system. The patient, who had a tracheostomy because of airway obstruction from the cystic hygroma, was found dead with his tracheostomy tube on the floor next to him. Complications of cystic hygroma include infiltration of the neck causing airway obstruction, dysphagia, pain, and obstructive sleep apnea.
Assuntos
Obstrução das Vias Respiratórias/etiologia , Asfixia/etiologia , Neoplasias Laríngeas/patologia , Linfangioma Cístico/patologia , Morte Súbita/etiologia , Humanos , Masculino , Traqueostomia , Adulto JovemRESUMO
BACKGROUND: Eosinophilic coronary periarteritis (ECPA) is a rare disease found in cases of sudden cardiac death due to coronary vasospasm or spontaneous coronary artery dissection. Currently, the etiology, pathogenesis, and pathophysiology of ECPA are unknown. Cases of ECPA with a history of allergic disorders are rare. Only one case of ECPA with tissue eosinophilia in another organ has been reported. METHODS: A 50-year-old male suddenly died after complaining of chest pain. An autopsy with histopathologic analysis was performed. RESULTS: A short segment of the left anterior descending artery had ECPA with dense eosinophilic inflammation of the adventitia and mild atherosclerosis. There were findings atypical of ECPA including mild focal eosinophilic infiltration of the intima and media associated with proliferation of vasa vasorum, fragmented internal and external elastic laminae, and fibrosis of the media. In addition, eosinophilic inflammation of the esophagus without mucosal involvement was present. The eosinophilic inflammation of the coronary artery and esophagus was accompanied by an increased number of mast cells. CONCLUSIONS: This case suggests that ECPA and atherosclerosis may act synergistically by induction of inflammation and vasa vasorum neovascularization. Vasa vasorum and mast cell infiltration may trigger vasospasm and spontaneous coronary artery dissection. Although concurrent tissue eosinophilia elsewhere is rarely observed in cases of ECPA, collective analysis of these cases may elucidate the etiology and pathophysiology of ECPA.
Assuntos
Arterite/complicações , Doença da Artéria Coronariana/complicações , Vasos Coronários/patologia , Morte Súbita Cardíaca/etiologia , Eosinofilia/complicações , Esofagite Eosinofílica/complicações , Eosinófilos/patologia , Esôfago/patologia , Arterite/patologia , Autopsia , Doença da Artéria Coronariana/patologia , Morte Súbita Cardíaca/patologia , Eosinofilia/patologia , Esofagite Eosinofílica/patologia , Evolução Fatal , Humanos , Imuno-Histoquímica , Masculino , Mastócitos/patologia , Pessoa de Meia-Idade , Neovascularização PatológicaRESUMO
Cardiac fibromas are benign primary tumors composed of connective tissue and fibroblasts. These uncommon tumors are primarily found in the pediatric population, and their prevalence among the adult population is exceedingly rare. We report a case of an adult with nonspecific symptoms, who was subsequently found to have a solitary mass located in the left ventricle. This case highlights an unusual finding in an adult who through various imaging modalities, surgical excision, and immunohistological analysis was found to have a cardiac fibroma.
RESUMO
Excessive ethanol consumption is a leading preventable cause of death in the United States. Much of the harm from ethanol comes from those who engage in excessive or hazardous drinking. Rectal absorption of ethanol bypasses the first pass metabolic effect, allowing for a higher concentration of blood ethanol to occur for a given volume of solution and, consequently, greater potential for central nervous system depression. However, accidental death is extremely rare with rectal administration. This case report describes an individual with klismaphilia whose death resulted from acute ethanol intoxication by rectal absorption of a wine enema.