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1.
Laryngeal cysts are benign, uncommon lesions of the larynx that have been reported on rare occasions to cause sudden death in infants and adults by acute airways obstruction. In this report, we document the sudden death of a 36-year-old woman from a previously undiagnosed, asymptomatic laryngeal saccular cyst that presented with acute, and consequent fatal, airway obstruction. Difficulty during intubation, both in theater and in emergency settings, is a frequent presenting problem. This can have significant medicolegal implications in determining possible negligence. The diagnosis, classification, and management of such cysts, and their importance to both the forensic pathologist and clinicians are discussed. 相似文献
2.
Pseudoaneurysm formation may be a late complication of vascular grafting. A case of sudden death in an 83-year-old woman with a previous aortobifemoral bypass graft is reported that was due to spontaneous hemorrhage from a pseudoaneurysm of the graft site that had eroded through the overlying skin and subcutaneous tissues. Pseudoaneuryms do not have to be of a particularly large size for rupture to occur. Social isolation and age-related cognitive impairment may delay treatment in older individuals resulting in a lethal outcome. The elderly are also more vulnerable to serious morbidity and death under these circumstances owing to significant underlying cardiovascular and respiratory disease and/or anticoagulant medication. Rarer conditions that may cause pseudoaneurysms include tumors and vasculidites. The possibility of an infectious contribution to the pseudoaneurysm should be considered and microbiological sampling undertaken. 相似文献
3.
Siddhartha Das M.B.B.S. M.D. Bhawana Badhe M.B.B.S. M.D. Asma Bibi M.B.B.S. M.D. Manoj K. Mohanty M.B.B.S. M.D. 《Journal of forensic sciences》2015,60(1):236-239
We report the case of a young man with a history of sudden death. On autopsy, a large retroperitoneal mass was found along with secondaries in the liver and lungs. No testicular abnormality was detected on palpation. Based on histopathological examination, it was diagnosed to be a case of choriocarcinoma. Unfortunately, it was not definitively determined whether the retroperitoneal mass represents the primary tumor or secondary involvement with testes being the primary source. It is important that forensic pathologists are aware of this disease as a potential cause of sudden death. The main focus of the paper is the approach of a forensic pathologist to a case of a sudden death when an unexpected and undiagnosed tumor is found in the retroperitoneum and not much information is available about the clinical history of the deceased. 相似文献
4.
36例脑血管畸形猝死案例及法医病理学分析 总被引:2,自引:0,他引:2
目的探讨脑血管畸形猝死的法医病理学特点和检查方法。方法对1997年至2006年10月四川华西鉴定中心所做36例脑血管畸形猝死病例进行分析。结果脑血管畸形猝死以10~49岁男性为主,有25例(69.44%)。18例(50%)发病前有明显诱因。18例(50%)在发病后1h内迅速死亡。脑血管畸形猝死的病理类型以脑动静脉畸形最为常见,有33例(91.67%)。24例(66.67%)发生于脑底部、桥脑和小脑。破裂出血是脑血管畸形猝死的直接死因,出血类型以蛛网膜下腔出血最为常见,有22例(61.11%)。脑血管畸形部位和形态复杂多变,常规检查方法不能满足鉴定的需要。结论脑血管畸形猝死的鉴定百分之百准确比较困难,熟悉其法医病理学特点,掌握多种检查方法,才能做出客观、全面、准确的鉴定结论。 相似文献
5.
Marie Brix Ley M.D. Maiken Kudahl Larsen M.D. Ph.D. 《Journal of forensic sciences》2019,64(1):295-297
Cardiovascular disease is the leading cause of sudden death in the world. The etiology of sudden cardiac death involves a wide range of diseases, but seldom pericardial cysts. A pericardial cyst is an uncommon cyst usually located in the middle mediastinum and rarely in the posterior part. They are usually harmless and asymptomatic. Here, we present a case of a 63‐year‐old woman who presented with dyspnea and hoarseness, but died suddenly after a CT scan was attempted. The detailed forensic pathologic and histologic examination revealed a pericardial cyst located in the posterior mediastinum. Toxicology and biochemistry tests, including tryptase, found no competing cause of death. 相似文献
6.
A 44‐year‐old man collapsed after complaining of difficulty breathing. Layer dissection of the neck at autopsy revealed a large mixed internal and external laryngopyocele occluding the upper airway. It contained 30 mls of yellow‐gray pus. Mechanisms of death in laryngoceles involve obstruction of the opening into the larynx resulting in accumulation of mucus or air within the sac causing airway occlusion. Once infection supervenes, deaths in laryngopyocoeles result either from accumulated pus causing airway occlusion from a mass effect (as in the current case) or the discharge of pus into the airway causing death from aspiration. Sudden death in laryngopyoceles is a very rare event that requires careful dissection at autopsy to demonstrate the characteristics of the underlying lesion and the possible mechanism of death. Laryngopyocele should be considered in the differential diagnosis of natural conditions causing acute, potentially lethal, upper airway obstruction. 相似文献
7.
Octavio Carvajal‐Zarrabal Ph.D. Patricia M. Hayward‐Jones M.Sc. Cirilo Nolasco‐Hipolito Ph.D. Dulce Ma. Barradas‐Dermitz M.Sc. Ana Laura Calderón‐Garcidueñas M.D. Ph.D. Noé López‐Amador M.D. M.S.F.Sc. 《Journal of forensic sciences》2017,62(5):1332-1335
In the daily practice of forensic pathology, sudden cardiac death (SCD) is a diagnostic challenge. Our aim was to determine the usefulness of blood biomarkers [creatine kinase CK‐MB, myoglobin, troponins I and T (cTn‐I and T), and lactate dehydrogenase] measured by immunoassay technique, in the postmortem diagnosis of SCD. Two groups were compared, 20 corpses with SCD and 8 controls. Statistical significance was determined by variance analysis procedures, with a post hoc Tukey multiple range test for comparison of means (p < 0.05). SCD cases showed significantly higher levels (p < 0.05) of cTn‐T and cTn‐I compared to the control group. Although only cases within the first 8 h of postmortem interval were included, and the control group consisted mainly of violent death cases, our results suggest that blood troponin levels may be useful to support a diagnosis of SCD. 相似文献
8.
Despite the fact that brain arteriovenous malformations (BAVMs) are a possible cause of sudden and unexplained death, very few papers have discussed their importance in the forensic context. BAVMs consist of tangled masses of tortuous arteries and veins devoid of intervening capillaries that frequently extend from brain parenchyma into the subarachnoid space. Apart from BAVMs, three major groups of vascular malformations of the brain are known: cavernous hemangioma, venous angioma, and capillary telangiectasia. BAVMs and cavernous hemangioma often cause hemorrhages, while venous angioma and capillary telangiectasia are typically asymptomatic. Presented here is the case of a 14-year-old girl who died from a ruptured BAVM. The present case is a reminder that the forensic pathologist should be able to recognize BAVMs and to differentiate it from other types of vascular malformations. Although rare, it is a cause of sudden death not to be overlooked, especially in children. 相似文献
9.
Saint-Martin P O'Byrne P Gaulier JM Martin-Dupont S Peyclit A Paraf F 《Journal of forensic sciences》2012,57(3):829-831
Acute promyelocytic leukemia (APL) is a subtype of acute myelogenous leukemia frequently associated with clotting abnormalities and severe hemorrhagic diathesis. The disease is associated with a high incidence of early fatal hemorrhage. We report the sudden death of a 40-year-old male without significant medical history in which foul play had been initially suspected. A thorough postmortem investigation performed on the decedent lead to the diagnosis of APL. Cause of death was a cerebellar hematoma. Underlying APL should be considered in the differential diagnosis when unexplained bleeding is encountered in a decedent. This case emphasizes the value of routinely collecting bone marrow during an autopsy to enable accurate testing and diagnosis. 相似文献
10.
Cristian Palmiere M.D. Maria del Mar Lesta M.D. Jessica Vanhaebost M.D. Patrice Mangin M.D. Ph.D. Marc Augsburger Ph.D. Pierre Vogt M.D. 《Journal of forensic sciences》2014,59(3):836-840
We herein report the case of a 36‐year‐old man who died suddenly after a fight with another man. Forensic investigations included unenhanced computed tomography, postmortem angiography, autopsy, histology, neuropathology, toxicology, and biochemistry and allowed a traumatic cause of death to be excluded. An electrocardiogram recorded some years prior to death revealed the presence of an early repolarization pattern. Based on the results of all investigations, the cause of death was determined to be cardiac arrhythmia and cardiac arrest during an emotionally stressful event associated with physical assault. Direct third party involvement, however, was excluded, and the manner of death was listed as natural. The case was not pursued any further by the public prosecutor. 相似文献
11.
Fentanyl concentrations in 23 postmortem cases from the hennepin county medical examiner's office 总被引:2,自引:0,他引:2
Thompson JG Baker AM Bracey AH Seningen J Kloss JS Strobl AQ Apple FS 《Journal of forensic sciences》2007,52(4):978-981
The purpose of this study was to compare blood fentanyl concentrations in fentanyl-related deaths with fentanyl concentrations found incidentally at autopsy, as well as with fentanyl concentrations found in hospitalized patients receiving fentanyl. Between the years 1997 to 2005, 23 fentanyl-positive postmortem cases were identified. Nineteen of 23 (82.6%) cases were deemed to be drug overdoses. Fentanyl alone was responsible for 8 of the 19 (42.1%) overdose deaths. Mean and median fentanyl concentrations were 36 (SD 38) microg/L and 22 microg/L, respectively, range 5-120 microg/L. Seven of the cases were accidental, one undetermined. The remaining 11 of the 19 (57.9%) cases were mixed drug overdoses. Fentanyl concentrations in these cases were 31 (SD 46) microg/L, range 5-152 microg/L. All of the mixed drug overdoses were determined to be accidental. Four cases where fentanyl was considered an incidental postmortem finding were determined to be natural deaths. In hospitalized inpatients (n = 11) receiving fentanyl 2 of the patients receiving fentanyl for chronic pain for more than 3 months had concentrations of 8.5 microg/L and 9.9 microg/L. The other nine inpatient concentrations were less than 4 microg/L. In conclusion, blood fentanyl concentrations found in cases where fentanyl alone was determined to be the cause of death were similar to cases where fentanyl was part of a mixed drug overdose. There was also considerable overlap between fentanyl concentrations in fentanyl-related overdose deaths compared to hospitalized patients being treated for chronic pain. Fentanyl concentrations in postmortem cases must be interpreted in the context of the deceased's past medical history and autopsy findings. 相似文献
12.
13.
Camille Boulagnon M.D. B.S. Nicolas Leveque Pharm.D. Ph.D. Fanny Renois Ph.D. Laurent Andreoletti Pharm.D. Ph.D. Paul Fornes M.D. Ph.D. 《Journal of forensic sciences》2012,57(6):1650-1655
Abstract: In March 2009, a new strain of influenza A/H1N1 virus was identified in Mexico, responsible for a pandemic. Worldwide, more than 13,500 patients died, most often from acute respiratory distress syndrome. Because sudden death cases were rare, involving mostly young apparently healthy persons, influenza A/H1N1 (2009)‐related deaths may be misdiagnosed, which can raise medico‐legal issues. Case history: we report on an unexpected out‐of‐hospital death involving a young male with no past medical history and no vaccination. Fever was his only symptom. Laboratory tests: histology showed patchy necrotic foci with mononuclear inflammation in the lungs. The heart was histologically normal, but virological analyses using molecular biology on frozen myocardial samples showed high virus load. In conclusion, this case report shows that influenza A/H1N1 (2009) virus can be a cause of sudden cardiac death in the young and demonstrates the importance of quantitative virological analyses for the diagnosis of myocarditis. 相似文献
14.
Given that most fatal hangings are suicidal and occur in locations that have been selected to conceal this activity (thus maximizing the chances of a lethal outcome), there has been very little corroboration of the speed with which unconsciousness and death may occur. A 35-year-old male is reported who committed suicide by hanging immediately after talking to his spouse. Police investigations confirmed her reliability as a witness indicating that lethal anoxia in this case had occurred within a very short time (most likely in less than 1 min) of suspension. The speed with which death may result from hanging not only gives an insight into fatal pathophysiological mechanisms, but also provides useful information for situations where a lethal outcome is to be avoided, or is not intended. For example, individuals at risk of suicide who are being monitored in institutional facilities need to be constantly under direct visual surveillance as significant hypoxia can be rapidly induced, parents and caregivers with infants and children in potentially unsafe sleeping environments need to realize how swiftly death or irreversible anoxic brain damage may occur from neck compression, and those who engage in recreational asphyxia should be informed just how quickly a fatal outcome may ensue. 相似文献
15.
Primary cardiac tumors are rare, with an autopsy incidence of 0.03%. Seventy-nine percent to 85% of primary cardiac tumors are benign, and of the benign tumors, cardiac hemangiomas account for 5-10% of cases. Most cardiac hemangiomas are asymptomatic and are discovered incidentally at autopsy, or by echocardiography, computerized tomography, or magnetic resonance imaging. We report a case of sudden death owing to cardiac hemangioma in a 22-year-old woman who collapsed while shopping and became unresponsive. The autopsy revealed a hemorrhagic mass on the surface of the right atrium which was infiltrating and replacing the wall of the right atrium; histopathological examination confirmed the tumor was a cavernous hemangioma. Fewer than 20 cases of right atrial cavernous hemangiomas have been reported in English literature, emphasizing the rarity of our case. 相似文献
16.
Omalu BI Lindner JL Janssen JK Nnebe-Agumadu U Weedn V 《Journal of forensic sciences》2007,52(6):1355-1358
We report two cases of sudden unexpected death in two unrelated African American female infants, 2 months and 4 months old. Both infants were attended to by the same babysitter in the same apartment and died 39 days apart in the same bed and in the same bedroom. The autopsy of the first infant revealed sudden unexplained death in an infant. Toxicologic analysis for carbon monoxide (CO) was not performed because it was not suspected. When the second infant died, investigation into the ambient air quality within the apartment revealed high levels of CO emanating from a poorly ventilated and defective hot water heater, which was located across a hallway from the bedroom where the two babies died. CO saturation levels in the postmortem blood samples of the two babies were elevated and were similar (13% and 14%). Nicotine and cotinine were not detected in the blood sample of the two infants. Cherry-red livor mortis was absent. Acute CO intoxication was determined to be the underlying cause of these two unexpected deaths. These two cases underscore the need to integrate ambient air analysis and postmortem CO analysis as routine components of the comprehensive death investigation of infants who die suddenly and unexpectedly. 相似文献
17.
Abstract: Severe external bleeding due to varicose vein rupture is a rare complication of this frequent venous pathology. Venous bleeding can be very intensive and can be mistaken for arterial hemorrhage. A rare case of fatal varicose vein rupture with an example of an incorrect and ineffective first-aid technique in a 43-year-old man is reported here with a review of the recent literature. The victim was found on a sand stack, not far from his domicile in a large pool of blood. The external examination revealed a flat ulcer on the internal surface of the right shank. On dissection, the lesion contained a perforation that was continuous with superficial veins arising from a varicosed saphenous vein. The man tried to give himself first aid, due to the massive bleeding that he probably predicted arterial bleeding and applied the ligature closer to the heart above the bleeding defect, thereby not stopping the venous bleeding but exacerbating it. Death was caused by a hypovolemic shock because of external hemorrhage from a varicose vein. 相似文献
18.
Abstract: The emergence of drug-resistant tuberculosis (TB) poses a major threat to TB control efforts. We report a case of a 50-year-old man with pulmonary TB. The scene investigation had initially suspected for homicide; however, the result of medico-legal autopsy demonstrated natural cause of death. Statistical data suggest that the rates of national mortality by respiratory TB decreased in the last decades in Hungary; however, an increasing TB mortality was detected in the capital Budapest. Facing a new mortality trend in TB, the forensic scene investigation and determination of manner of death represent new challenges for practitioners. 相似文献
19.
Byard RW 《Journal of forensic sciences》2007,52(5):1164-1170
Neurofibromatosis types 1 and 2 are inherited neurocutaneous disorders characterized by a variety of manifestations that involve the circulatory system, the central and peripheral nervous systems, the skin, and the skeleton. Significant reduction in lifespan occurs in both conditions often related to complications of malignancy and hypertension. Individuals with these conditions may also be the subject of medicolegal autopsy investigation if sudden death occurs. Unexpected lethal events may be associated with intracranial neoplasia and hemorrhage or brainstem compression. Vasculopathy with fibrointimal proliferation may result in critical reduction in blood flow within the coronary or cerebral circulations, and aneurysmal dilatation may be associated with rupture and life-threatening hemorrhage. An autopsy approach to potential cases should include review of the history/hospital record, liaison with a clinical geneticist (to include family follow-up), a full external examination with careful documentation of skin lesions and nodules, measurement of the head circumference in children, photography, possible radiologic examination, a standard internal autopsy examination, documentation of the effects of previous surgery and/or chemo/radiotherapy, examination for specific tumors, specific examination and sampling of vasculature (renal, cerebral, and cardiac), formal neuropathologic examination of brain and spinal cord, possible examination of the eyeballs, examination of the gastrointestinal tract, histology to include tumors, vessels, gut, and bone marrow, toxicological testing for anticonvulsants, and sampling of blood and tissue for possible cytogenetic/molecular evaluation if required. 相似文献
20.
Sarcoidosis is a multisystem disease of uncertain etiology characterized by multifocal areas of discrete and confluent granulomatous inflammation that may rarely be responsible for sudden and unexpected death. Two cases are reported to demonstrate disparate pathological features in fatal cases, one involving cardiac sarcoidosis, and the other neurosarcoidosis with hypothalamic infiltration. Sarcoidosis in individuals dying suddenly may be completely unrelated to the death, contributory or causal. Cardiovascular causes of sudden death in sarcoidosis include arrhythmias associated with cardiomyopathy and ischemia, ventricular rupture, and cor pulmonale due to pulmonary hypertension; respiratory causes include hemorrhage and upper airway obstruction; central nervous system causes include arrhythmias from infiltration of autonomic centers, epilepsy, and obstructive hydrocephalus from brainstem involvement; and gastrointestinal deaths may be due to hemorrhage from esophageal varices associated with portal hypertension. The diagnosis relies on the demonstration of typical noncaseating granulomas and the exclusion of other infective and environmental diseases with similar histopathological findings. 相似文献