Examination of the Cerebellomedullary Cistern Using Postmortem Computed Tomography in Various Types of Intracranial Hemorrhage / 대한법의학회지

Intracranial hemorrhage is a major cause of sudden unexpected death and its identification is important for death investigations. Cisternal puncture of the cerebellomedullary cistern (CMC) can be used to identify intracranial hemorrhage during postmortem examination. Intracranial hemorrhage comprises various types of hemorrhage, and the possibility of hemorrhage identification by cisternal puncture can differ according to the type of intracranial hemorrhage. Postmortem computed tomography (PMCT) is non-invasive and can be performed before autopsy. In this study, we aimed to identify the hemorrhage in the CMC using PMCT in cases of various intracranial hemorrhage. PMCT was performed before the autopsy. Autopsy reports and PMCT were retrospectively reviewed for 108 cases of intracranial hemorrhage confirmed by conventional autopsy. Hemorrhagic regions showed ≥60 Hounsfield units on PMCT. Hemorrhage in the CMC was identified in 42.6% (46/108) by PMCT and was frequently identified in the cases of basal subarachnoid hemorrhage (SAH) (19/21). Hemorrhage in the CMC was identified in approximately 50% of patients with non-basal SAH and intracerebral hemorrhage. Detection of hemorrhage in the CMC by PMCT is hindered by several factors, such as dental artifacts. This study does not guarantee the usefulness of postmortem cisternal puncture. However, this study verified hemorrhage in the CMC according to the various types of intracranial hemorrhages using PMCT and showed its possibilities and limitations.

Forensic Considerations in Postmortem Cases of Sudden Death during or after Percutaneous Coronary Intervention: Data from The National Forensic Service in Korea, 2015 to 2021 / 대한법의학회지

Sudden death during or after percutaneous coronary intervention (PCI) could be led to potential medicolegal disputes. This study aimed to investigate the clinical and postmortem findings in PCI-related deaths-focusing on the current statusto inform preventive strategies against these fatalities. Forty-three cases were retrieved from the National Forensic Service's postmortem records between 2015 and 2021, and the corresponding postmortem findings and clinical information were analyzed. The analyses revealed a relatively consistent annual incidence of PCI-related deaths. Immediate deaths during or shortly after PCI occurred in 17 cases (39.5%), and delayed PCI-related deaths after discharge from the hospital occurred in 26 cases (60.5%). The causes of PCI-related deaths in the postmortem cases were categorized into four groups: PCI complications (11 cases, 26%), acute myocardial infarction (23 cases, 53%), ischemic heart disease (8 cases, 19%), and others (1 case, 2%). Postmortem examinations played a critical role in determining the cause of death and obtaining medical evidence, including pathological findings of the heart as well as those of coronary artery and stent insertion. Our findings suggest that a detailed examination of the heart, coronary arteries, stent status, and atherosclerosis in PCI-related deaths could help provide more accurate information as medical evidence and prevent/resolve potential medicolegal issues. Further, this could advance our understanding of PCI-related deaths and inform future preventive strategies.

Cardiac and Muscular Pathology on Autopsy in a Man with Duchenne Muscular Dystrophy / 대한법의학회지

Duchenne muscular dystrophy (DMD) is a degenerative muscle disease characterized by a progressive decline in muscular function, with cardiomyopathy in the later stages. We report the autopsy findings of a 29-year-old man with DMD. He had been stable with the assistance of mechanical ventilation until he was found unconscious, without known cause. External examination confirmed generalized muscular atrophy and contracture consistent with his clinical history. Histopathology revealed varying degrees of fibrofatty changes in the muscles, with the calf muscles being the most extensively affected, followed by the diaphragm and heart. The cardiac muscle showed the least involvement and the pathology was confined to the left ventricular wall and the interventricular septum, exhibiting a unique morphology of fibrosis resembling stretched springs. The cause of death was attributed to cardiac failure due to DMD progression. This case highlights the clinical course of DMD, emphasizing the need for thorough examination of both skeletal and non-skeletal muscles, including the cardiac muscles, to obtain a better understanding of the disease.

Needles in the Lungs: An Autopsy Case of Pulmonary Ossification in a Putrefied Body / 대한법의학회지

Forensic autopsy is performed to investigate a death. However, this is difficult in some cases, particularly in putrefied bodies. Pulmonary ossification is a rare pathological process, characterized by progressive and metaplastic ossification, which leads to the formation of small bony fragments in the pulmonary tissue. This condition can develop within the pulmonary tissues that are injured due to various causes. Metastatic and dystrophic calcification occur in normal tissues in conditions of deranged calcium metabolism and dead or degenerative tissue, respectively. Here, we describe the case of a 54-year-old man who lived alone and whose putrefied body was discovered by his landlord. A forensic pathologist identified needle-like sharp materials in both the lower lobes of the lungs during autopsy. Microscopic examination revealed dendriform pulmonary ossification with calcification. After autopsy, his medical history, including chronic kidney disease, was recorded by forensic pathologist. A review of his past medical history and comprehensive postmortem examination findings of the gross dissection, microscopic examination, and postmortem laboratory tests led to the determination of the cause of death as renal problems.

Sudden Unexpected Deaths due to Multiple Metastasis of Colon Cancer: With a Focus on Cardiac and Dural Metastasis / 대한법의학회지

A malignancy is a fatal condition that could occur through various mechanisms. Forensic pathologists sometimes find unexpected findings during autopsy and post-mortem (PM) tests. Colorectal cancer is one of the leading causes of cancer-related deaths worldwide. The deceased was a 64-year-old man with a medical history of right hemicolectomy due to colon cancer approximately two years earlier. He was found dead at his home. He was admitted to the hospital due to subdural hemorrhage (SDH) two days prior to his demise and was discharged without the permission of the doctor after one day of hospitalization. An autopsy was performed within two days of his death. After gross dissection, the cause and manner of death were assumed to be SDH and unnatural death, respectively. Microscopic examination revealed fresh SDH and dural metastasis of signet-ring cell carcinoma. Furthermore, metastasis was identified in the heart, stomach, and peritoneum. Immunohistochemical examination revealed cancer cells to originate from the colon. After meticulous PM examination, including gross dissection, microscopic examination, PM computed tomography, and PM laboratory tests, the cause and manner of death were determined as SDH and natural death, respectively. This case report highlights the importance of comprehensive PM evaluation for investigating death.