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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.
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We present two cases of death associated with chronic methamphetamine abuse. Several findings were observed in chronic methamphetamine abuse; pathologic changes in the heart and coronary artery, pulmonary embolism by foreign materials (drug materials), small scars on the subcutaneous vein on the arms with skin infection and sepsis, and so on. These complications can be fatal pathological findings that explain sudden death. The toxicological test results should be carefully interpreted; the presence of methamphetamine in the toxicological results should not automatically be interpreted as acute intoxication. A meticulous postmortem examination with review of the scene, circumstances and past history is crucial in identifying these findings and interpreting them appropriately.
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We present the postmortem findings of an unexpected death due to acute myocardial infarction (AMI) with microthrombi and thrombosis in other vessels after the first dose of coronavirus disease 2019 (COVID-19) vaccination (ChAdOx1 nCov-19). The deceased was a 69-year-old woman who complained of nonspecific symptoms shortly after vaccination and was found dead on the sixth day. Postmortem examination revealed AMI and complications (left ventricular rupture, hemopericardium) with microthrombi in small cardiac vessels, which are similar to the characteristic findings of myocardial injury caused by microthrombi in patients with COVID-19. Nonobstructive thromboembolism in the pulmonary arteries and inferior vena cava, and fibrin microthrombi in some small vessels in the brain were also observed. It is unclear whether these findings are associated with COVID-19 vaccination, and further comprehensive studies are needed.
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The deceased was a 6-month-old male infant who was transferred to the hospital due to jaundice and vomiting. During admission, subdural hemorrhage and retinal hemorrhage were observed; additionally, a rib fracture was identified on the previous radiography images, which had eventually healed by the time of the follow-up study. This case was reported to the police, alleging child abuse, which led to a medicolegal dispute between the hospital and the deceased's parents. In addition, bleeding tendency and coagulopathy related to vitamin K deficiency were also found. The past history revealed that the deceased had diarrhea, jaundice, and experienced several episodes of acholic stools, and low levels of vitamin D at birth. On postmortem examination, the brain already revealed liquefactive necrosis, but subdural hemorrhage was still observed. The optic nerves of both eyes revealed hemorrhage with focal retinal hemorrhage.No definite fracture was identified; however, osteopenia was observed in the long bones. The liver showed septal fibrosis and cholestasis which is nearly biliary cirrhosis, and mild dilation of the intrahepatic and extrahepatic bile ducts, suggesting a choledochal cyst. This case illustrates that subdural hemorrhage related to vitamin K deficiency could occur in an infant with a choledochal cyst.When subdural hemorrhage is encountered in a child with what is considered an intentional head injury, the possibility of spontaneous hemorrhage should be excluded.
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We present the case of a 48-year-old woman who complained of sustained dyspnea and newly developed dyspnea, who then suddenly and unexpectedly expired during bronchoscopy. On postmortem examination, the deceased had advanced gastric cancer as a primary tumor. Frequent lymphatic tumor emboli were observed with some pulmonary lymphangitic carcinomatosis (PLC), and pulmonary tumor thrombotic microangiopathy (PTMA). PLC and PTMA are lethal forms of pulmonary metastasis, and PTMA can lead to sudden death. The characteristic findings of PLC and PTMA in the deceased were not predominant, however, and the clinical manifestation was not acutely deteriorating. These findings are, therefore, insufficient to explain the deceased's sudden death. Clinically, the deceased manifested hypoxemia, bradycardia and cardiac arrest during bronchoscopy and then soon expired, suggesting the possibility of cardiovascular complication related to bronchoscopy. Despite several limitations, we assumed that the sudden unexpected death might have been induced by cardiovascular complications related to bronchoscopy and due to the underlying pathologic condition by PLC and PTMA.
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We present the case of a 48-year-old woman who complained of sustained dyspnea and newly developed dyspnea, who then suddenly and unexpectedly expired during bronchoscopy. On postmortem examination, the deceased had advanced gastric cancer as a primary tumor. Frequent lymphatic tumor emboli were observed with some pulmonary lymphangitic carcinomatosis (PLC), and pulmonary tumor thrombotic microangiopathy (PTMA). PLC and PTMA are lethal forms of pulmonary metastasis, and PTMA can lead to sudden death. The characteristic findings of PLC and PTMA in the deceased were not predominant, however, and the clinical manifestation was not acutely deteriorating. These findings are, therefore, insufficient to explain the deceased's sudden death. Clinically, the deceased manifested hypoxemia, bradycardia and cardiac arrest during bronchoscopy and then soon expired, suggesting the possibility of cardiovascular complication related to bronchoscopy. Despite several limitations, we assumed that the sudden unexpected death might have been induced by cardiovascular complications related to bronchoscopy and due to the underlying pathologic condition by PLC and PTMA.
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Feminino , Humanos , Pessoa de Meia-Idade , Hipóxia , Autopsia , Bradicardia , Broncoscopia , Carcinoma , Morte Súbita , Dispneia , Patologia Legal , Parada Cardíaca , Metástase Neoplásica , Neoplasias Gástricas , Microangiopatias TrombóticasRESUMO
BACKGROUND: The diagnostic criteria for bathtub drownings are not standardized, and the risk factors associated with bath-related deaths are unclear. METHODS: We analyzed a Korean nationwide database of bath-related deaths that occurred between January 2008 and December 2015. Eighty-four cases were enrolled after reviewing 31,123 autopsy records. RESULTS: The subjects' ages ranged from 18 to 91 years, with a mean age ± standard deviation of 61.3 ± 16.0 years. Bath-related deaths in the winter were approximately 4.6-fold greater than those in the summer. Of the 84 subjects, the primary cause of death in 57 (67.9%) was drowning in the bath; 24 (28.6%) drowned of other causes such as natural diseases, and 3 (3.6%) died of acute alcohol intoxication. We analyzed water-inhalation signs to establish criteria for bathtub drowning diagnosis. There were significantly higher incidences of hyperinflated lungs, water in the sphenoid sinus and stomach/duodenal contents, and Paltauf's spots (subpleural hemorrhage) in bathtub-drowned subjects compared to non-drowned individuals (P < 0.01). Multiple signs of water inhalation were significantly associated with bathtub drowning (P < 0.01). The two leading contributory causes of bath-related death were cardiovascular diseases and alcohol intoxication (binge drinking before bathing). CONCLUSION: The diagnosis of bath-related deaths could present considerable medico-legal problems; therefore, a comprehensive autopsy with a thorough scene investigation can clarify the cause of death in these situations. Preventive strategies for reducing such deaths should target alcohol drinking before bathing and long soaking times in bathtubs, especially among elderly individuals with preexisting cardiovascular diseases.
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Idoso , Humanos , Consumo de Bebidas Alcoólicas , Autopsia , Banhos , Doenças Cardiovasculares , Causas de Morte , Diagnóstico , Ingestão de Líquidos , Afogamento , Patologia Legal , Incidência , Inalação , Coreia (Geográfico) , Pulmão , Fatores de Risco , Seio Esfenoidal , ÁguaRESUMO
Aspergillus infection is the most common cause of death due to fungi in immunocompromised hosts. Aspergillus tracheobronchitis is an uncommon but severe form of invasive pulmonary aspergillosis, which is limited entirely or mainly to the tracheobronchial tree and can often be life-threatening. We report a case of a 54-year-old man who died from Aspergillus tracheobronchitis without an underlying disease. Autopsy revealed an extensive yellowish plaque adhering to the trachea and bronchial wall. The microscopic examination of the trachea and bronchus revealed septate branching hyphae of Aspergillus.
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Aspergillus infection is the most common cause of death due to fungi in immunocompromised hosts. Aspergillus tracheobronchitis is an uncommon but severe form of invasive pulmonary aspergillosis, which is limited entirely or mainly to the tracheobronchial tree and can often be life-threatening. We report a case of a 54-year-old man who died from Aspergillus tracheobronchitis without an underlying disease. Autopsy revealed an extensive yellowish plaque adhering to the trachea and bronchial wall. The microscopic examination of the trachea and bronchus revealed septate branching hyphae of Aspergillus.
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Humanos , Pessoa de Meia-Idade , Aspergillus , Autopsia , Brônquios , Bronquite , Causas de Morte , Fungos , Hifas , Hospedeiro Imunocomprometido , Aspergilose Pulmonar Invasiva , Traqueia , Traqueíte , ÁrvoresRESUMO
BACKGROUND: There has been a campaign by the National Education on Sleeping Habits and Living Environment, to reduce the incidence of sudden infant death syndrome (SIDS). However, more than 100 infants die suddenly and unexplainably before the age of 1 year in Korea. Long QT syndrome (LQTS), an inheritable cardiac disease, has been reported to likely be associated with up to 14% of SIDS cases. However, genetic studies of the association between SIDS and LQTS have not yet been conducted in Korea. METHODS: We conducted genetic analysis using genomic DNA extracted from paraffin-embedded tissue blocks from 200 SIDS cases autopsied between 2005 and 2013. We analyzed the following genetic mutations associated with LQTS, KCNQ1, SCN5A, KCNE1, KCNE2, KCNJ2, and CAV3. RESULTS: Of the 200 SIDS cases, 58% involved male infants (116 male and 84 female infants, respectively), the mean age was 140 days (median, 107 days; range, 24–270 days), and they were all of Asian-Korean ethnicity. SIDS IA category criteria comprised 45 cases (22.5%) while the rest were SIDS IB. Fifteen infants (7.5%) had R1193Q in SCN5A, of doubtful pathogenicity, and no pathogenic LQTS variants were observed. CONCLUSION: This genetic investigation of LQTS in SIDS showed a low diagnostic yield. These findings suggest that LQTS molecular autopsy could be cautiously conducted in selected cases with family involvement to improve the available genetic counseling information. Meanwhile, a national SIDS registry should be established to document and evaluate the genetic risk of SIDS in Korea.
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Feminino , Humanos , Lactente , Masculino , Autopsia , DNA , Educação , Aconselhamento Genético , Cardiopatias , Incidência , Coreia (Geográfico) , Síndrome do QT Longo , Estudos Retrospectivos , Morte Súbita do Lactente , VirulênciaRESUMO
Gasoline is a chemical compound of aliphatic and aromatic hydrocarbons, and it easily vaporizes because of its volatile characteristics. Gasoline inhalation may occur accidentally or intentionally in various situations which could result in acute non-lethal or lethal intoxication. Given that gasoline is widely used in everyday life, it is surprising that deaths related to gasoline inhalation rarely occur. We presented a rare case of unexpected death related to gasoline inhalation with the postmortem findings and features.
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Autopsia , Morte Súbita , Toxicologia Forense , Gasolina , Hidrocarbonetos Aromáticos , Inalação , Intenção , IntoxicaçãoRESUMO
Ehlers-Danlos syndrome type IV (EDS IV) is a hereditary disorder of the connective tissue, characterized by easy bruising, thin skin with visible veins, and spontaneous rupture of the large arteries, uterus, or bowel. EDS IV is caused by mutations of the gene for type III procollagen (COL3A1), resulting in insufficient collagen production or a defect in the structure of collagen. EDS IV can have fatal complications such as the rupture of great vessels or organs, which can cause hemorrhaging and sudden unexpected death. Here, we report a case of a 43-year-old female who collapsed after a struggle with a neighbor. In this patient, the bifurcation of the bilateral common iliac artery ruptured, with no evidence of trauma, inflammation, or atherosclerosis. Genetic analysis of COL3A1 showed the presence of a c.2771G>A (p.Gly924Arg) mutation, which may be associated with EDS IV. The forensic pathologist should consider the possibility that the spontaneous visceral or arterial rupture was caused by EDS IV. Genetic analysis is not currently a routine procedure during autopsy. However, in this case, we suggest that the patient possibly had an underlying EDS IV condition, and we recommended family members of the deceased to seek genetic analysis and counseling.
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Adulto , Feminino , Humanos , Ruptura Aórtica , Artérias , Aterosclerose , Autopsia , Colágeno , Colágeno Tipo III , Tecido Conjuntivo , Aconselhamento , Síndrome de Ehlers-Danlos , Artéria Ilíaca , Inflamação , Ruptura , Ruptura Espontânea , Pele , Útero , VeiasRESUMO
The concentration of glucose in the vitreous humor serves as an important diagnostic marker for diabetic mellitus in post-mortem examinations, as the vitreous humor can be easily collected and the glucose test using vitreous humor is not significantly affected by cell autolysis and hemolysis. For a quick and effective glucose test, we suggest a dipstick test of the vitreous humor during autopsy. The results were evaluated and compared with other methods for significance testing. In this study, vitreous humor was analyzed from 257 autopsy cases. Qualitative concordance rate of the dipstick test for glucose and the hexokinase test was 98.7%, positive prediction rate was 89.6%, and negative prediction rate was 100%. However, there was no significant correlation between the dipstick glucose test and the hexokinase test. We conclude that the dipstick glucose test is effective and useful for post-mortem glucose screening testing and for additional post-mortem diabetes testing. Recently, the importance of post-mortem glucose testing has increased with the increase in deaths from diabetes complications. The use of the dipstick glucose test in autopsy practice can improve forensic medicine in Korea.
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Autólise , Autopsia , Complicações do Diabetes , Medicina Legal , Glucose , Hemólise , Hexoquinase , Coreia (Geográfico) , Programas de Rastreamento , Corpo VítreoRESUMO
Medicolegal autopsies are a vital tool for obtaining reliable injury mortality data. This study statistically analyzed the data obtained from medicolegal autopsies performed in Korea in 2014. A total of 5,324 deaths were analyzed by sex, age, manner of death, and cause of death. With respect to the manner of death, 56.3% were recorded as unnatural deaths, 38.4% were natural deaths, and 5.3% had unknown causes. Of the 2,998 unnatural deaths, 41.0% were determined to be accidental deaths; 28.1%, suicidal; 16.1%, homicidal; and 14.8%, undetermined. Of the total number of unnatural deaths, 38.8% were trauma-related, wherein falls accounted for 32.7%. Asphyxiation accounted for 16.3% of unnatural deaths; of these, the predominant cause was hanging (59.4%). In addition, 15.0% of the unnatural deaths were due to drowning; 14.8%, poisoning; 11.3%, thermal injuries; 2.5%, complications arising from medical procedures; and 0.4%, electrocution, starvation, or neglect. Among the 2,042 natural deaths, heart diseases accounted for 49.0% and vascular diseases accounted for 17.3%. Of the 170 deaths among children under the age of 10, 38.8% were recorded as unnatural deaths, 54.1% were natural deaths, and 7.1% had unknown causes.
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Criança , Humanos , Autopsia , Causas de Morte , Interpretação Estatística de Dados , Afogamento , Cardiopatias , Coreia (Geográfico) , Mortalidade , Intoxicação , Inanição , Doenças VascularesRESUMO
Forensic autopsy service in a metropolitan area of Korea is well established and optimized for high population density based on high social system and infrastructures. However, forensic autopsy in rural areas in our country might be affected due to their low population density, and inconveniences related to special and temporal limitations as well as cultural and traditional limitation. Therefore, for an advanced and optimized model of forensic autopsy service in rural areas, we performed a retrospective analysis on the profile of forensic autopsy based on the eastern part of our nation for 8 years between 2005 and 2013 and analyzed them by cause of death, manner of death, demographic data, toxicological results, and additional information. Through our study we presented the profile of forensic autopsy practice in rural areas and suggested that it can be affected by such regional characteristics.
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Autopsia , Causas de Morte , Medicina Legal , Patologia Legal , Coreia (Geográfico) , Densidade Demográfica , Estudos Retrospectivos , População RuralRESUMO
Mushroom poisoning widely reported in Oriental and Western literature, is typically caused by accidental ingestion of toxic mushrooms that resemble edible mushrooms. Reports about poisoning due to species of Omphalotus, Amanita, Clitocybe, and other toxic mushroom species have been reported; toxicity depends on the mushroom species and the amount of toxin, which varies according to the climatic and environmental conditions. Symptoms of poisoning, such as unspecific nausea, vomiting, and diarrhea, as well as intestinal, hepatic and renal toxicities, also vary according to the mushroom species. Most patients recover with anti-muscarinic therapy and supportive care for nonspecific symptoms; however some cases of poisoning are fatal in children and elderly people. We report a case of sudden death due to mushroom poisoning in a 74-year-old woman, with hemorrhagic enteritis.
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Idoso , Criança , Feminino , Humanos , Agaricales , Amanita , Morte Súbita , Diarreia , Ingestão de Alimentos , Enterite , Intoxicação Alimentar por Cogumelos , Náusea , Intoxicação , VômitoRESUMO
A 44-year-old man was cutting an outer plate of a ship, at a depth of 25 m below sea level. Following a sudden explosion, he was discovered unconscious and was carried to the surface by other divers. There was no evidence of vital signs upon arrival at the hospital. Postmortem computed tomography, which was performed prior to autopsy, revealed massive pneumocephalus in the brain, pneumohemothorax, diffuse lung contusions with multiple traumatic lung cysts, air-fluid level in the cardiac chamber of the chest, and pneumoperitoneum in the abdomen. Postmortem external examination showed a circular abrasion on the jaw, diffuse subcutaneous emphysema, and contusion in the right upper arm. An internal examination revealed intravascular air bubbles in all four chambers of the heart, and diffuse pulmonary trauma including contusion, laceration, and multiple traumatic cysts. Blast injury to the chest, and air embolism due to the underwater explosion were established as the underlying cause of death.
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Adulto , Humanos , Abdome , Braço , Autopsia , Traumatismos por Explosões , Encéfalo , Causas de Morte , Contusões , Mergulho , Embolia Aérea , Explosões , Coração , Arcada Osseodentária , Lacerações , Pulmão , Pneumocefalia , Pneumoperitônio , Navios , Enfisema Subcutâneo , Tórax , Sinais VitaisRESUMO
Medicolegal autopsy is a vital tool for obtaining reliable injury mortality data. This study statistically analyzed data obtained from medicolegal autopsies performed in Korea in 2013. The aim of this study was to analyze various aspects of the 4,861 deaths that were categorized as unusual in Korea in 2013. A total of 4,861 deaths were analyzed by gender, age, manner of death, and cause of death. Of the 4,861 deaths, 3,542 (73.3%) were of men and 1,302 (26.7%) were of women. With respect to the manner of death, 54.4% were recorded as unnatural deaths, 38.8% were natural deaths, and 6.9% had unknown causes. Of the 2,642 unnatural deaths, 45.0% were determined to be accidental deaths, 26.3% suicidal, 16.9% homicidal, and 11.8% undetermined. Of the total number of unnatural deaths, 42.1% were trauma-related deaths, for which falling down accounted for 33.8%. Asphyxiation accounted for 16.0% of unnatural deaths, and of these, the predominant cause was hanging (58.8%). In addition, 14.4% of deaths were due to drowning, 12.9% poisoning, 11.0% thermal injuries, 1.8% complications arising from medical procedures, and 0.8% electrocution, starvation, or neglect. Among the 1,886 natural deaths, heart diseases accounted for 52.0% and vascular diseases accounted for 16.9%. Of the 196 deaths among children under the age of 10 years, 41.8% were recorded as unnatural deaths, 45.1% were natural deaths, and 1.5% had unknown causes.
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Criança , Feminino , Humanos , Masculino , Autopsia , Causas de Morte , Interpretação Estatística de Dados , Afogamento , Cardiopatias , Coreia (Geográfico) , Mortalidade , Intoxicação , Inanição , Doenças VascularesRESUMO
Acute necrotizing esophagitis (AEN), also called "black esophagus," is a rare disorder with an unknown pathogenesis. Endoscopic findings generally show black pigmentation throughout the esophagus. This case also offered rare views of the gross anatomy of this disorder. Histological examination revealed that the mucosal and submucosal layers of the esophagus were involved in the severe necrotizing inflammation. The chief manifestation of this disease is hematemesis from hemorrhage of the upper gastrointestinal tract with a typically multifactorial etiology. AEN is also characterized by a clear boundary at the gastroesophageal junction where the necrosis stops. In this study, we report an autopsy case of a 61-year-old man with necrotizing inflammation throughout the esophagus and esophageal necrosis from the laryngopharynx to the gastroesophageal junction. The patient was a disabled person with a history of alcohol abuse who was also diagnosed with mild coronary arteriosclerosis and fatty liver on the basis of the underlying diseases. In this case, the main etiology for poor perfusion from the distal esophageal area was likely underlying illness, history of alcoholism, and malnutrition.
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Humanos , Pessoa de Meia-Idade , Alcoolismo , Autopsia , Doença da Artéria Coronariana , Pessoas com Deficiência , Esofagite , Junção Esofagogástrica , Esôfago , Fígado Gorduroso , Hematemese , Hemorragia , Hipofaringe , Inflamação , Desnutrição , Necrose , Perfusão , Pigmentação , Trato Gastrointestinal SuperiorRESUMO
Hepatocellular carcinoma (HCC) is one of the leading causes of death in Korea. Chronic hepatitis, alcoholic liver disease and liver cirrhosis are predisposing factor of HCC. Bleeding tendency and hemorrhage resulting from reduced production of coagulation factors or portal hypertension are not uncommon in HCC, moreover spontaneous hemoperitoneum also can occur. Spontaneous hemoperitoneum is a complication of HCC, that is caused by the rupture of HCC mass which abuts on the hepatic capsule. However hemoperitoneum also occurs due to the rupture of vasculature of the mass. Emergency laparotomy is the recommended treatment, however these patients exhibit poor prognosis because of hemodynamic instability followed by combined liver disease. Herein, we report a case of spontaneous hemoperitoneum due to the rupture of subcapsular vessels with invasion of HCC in a 39-years-old man, whose tumor was left undetected.