Seat-belt injuries to the left common carotid artery and left internal carotid artery

Seat-belt injuries to the neck in a traffic accident or any trauma to the neck in other situations can cause tearing of the inner surface of the carotid arteries and lead to the formation of a fresh thrombus, or can cause partial to complete transection of the carotid arteries.     

Traumatic bilateral vertebral artery dissection

Traumatic vertebral artery dissection is not often seen by forensic pathologists, and cases investigated are scarce in the forensic literature. We present the case of a 40-year-old woman cyclist who was struck by a car while wearing a helmet, and was neurologically near normal immediately thereafter at Emergency. She presented 48 h later with acute right hemiparesis, decreasing level of consciousness, and unsteadiness. CT revealed massive cerebellar infarction. CT angiography was normal. The patient died in coma 7 days after injury and autopsy revealed bilateral edematous cerebellar infarction and bilateral vertebral artery dissection. Rotational neck injury and mural tear in the wall of the Atlantic parts of both vertebral arteries is suggested as the possible mechanism of the arterial injury. Head and neck injuries are reported as a precipitating cause of vertebral artery injury. The possible influence of trauma may be further underestimated if longer intervals between vessel dissection and ischemia occur. The current case illustrates that "talk-and-die" syndrome may be due to occult vertebral artery dissection, possibly bilateral. In forensic cases of delayed death after mild trauma to the head and neck, the vertebral arteries should be examined for the cause of death.     

Renal artery bullet embolism.

Bullet embolism is a well-recognized phenomenon. While bullet embolism is not common, renal artery bullet embolism appears to be very rare. We report three cases of bullet embolism to a renal artery. Autopsy findings and bullet types are presented. Such cases are of particular interest to both the medical examiner and the clinician. Failure to consider this phenomenon clinically could lead to infarction of a kidney. A consideration of this phenomenon at autopsy could shorten the dissection time required to retrieve the bullet.     

Homicidal cerebral artery aneurysm rupture

When a normally natural mechanism of death is induced by physical injury or intense emotional stress, it is appropriate to rule the manner of death as something other than natural. When the case-specific circumstances are such that the death occurs as a result of the criminal activity of another person, it is acceptable to rule such deaths as homicides. Presented herein is a case of homicidal cerebral artery aneurysm rupture occuring in an intoxicated, 46-year-old man who was punched in the face by another individual. The details of the case are presented, followed by a discussion of the controversies that exist when dealing with such cases. Guidelines for investigating similar deaths are presented, with emphasis on the timing of the trauma in relation to onset of symptoms due to aneurysm rupture.     

Dissecting aneurysm of the hepatic artery

Aneurysms of the hepatic artery are rare and frequently diagnosed only at autopsy. First described by Wilson over 250 years ago, less than 400 cases have been reported in the literature (1,2). Dissection of these aneurysms is documented even less frequently, with only 11 cases reported in a review by Larson et al. (3). A case of sudden death from dissection and rupture of such an aneurysm was seen at the Westchester County Medical Examiner's Office, New York.     

Femoral artery pseudoaneurysm and sudden death

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.     

Rupture of splenic artery aneurysm.

Three cases of death from splenic artery aneurysm rupture were encountered from 1988 to 1991 at the Philadelphia Medical Examiner's Office. In two cases, cocaine was detected in the blood and was believed to have precipitated the rupture. Toxicologic testing for cocaine should be performed in all cases of splenic artery aneurysm rupture and its presence should be interpreted properly as contributory rather than incidental to death.     

Vertebral artery laceration mimicking elder abuse

Elder abuse was first described almost 30 years ago. Today, approximately 1 in 25 elders is abused each year in the United States. A newly described form of domestic violence, the incidence of elder abuse will surely increase as the elderly population grows. Physical abuse/inflicted trauma is generally considered the most extreme form of elder mistreatment and includes blunt trauma, sexual assault, traumatic alopecia, and burns. Elder homicide is usually due to gunshot wounds, blunt trauma, stab wounds, or asphyxia. However, the difficult aspect of assessing the possible elder abuse homicide victim is delineating such inflicted trauma from accidental trauma. We report the case of a 94-year-old "demented" male, who reportedly fell out of his wheelchair. He was transported to a local emergency room, where he became unresponsive during examination. He experienced respiratory distress and was pronounced dead shortly thereafter. At autopsy, he had periorbital contusions and a midline abrasion between the eyes, with underlying supraorbital contusion. The skull, brain, and spinal cord were unremarkable for signs of trauma. The major traumatic finding was in the neck region. Neck dissection revealed hemorrhage extending from the base of the skull to the level of T-1 and anteriorly about the soft tissues, strap muscles, and vasculature. The strap muscles were individually examined and were free of hemorrhage. The carotid arteries and jugular veins were unremarkable. The larynx, hyoid, and thyroid were intact, with only surrounding hemorrhage. Further examination revealed a horizontal fracture of the C5 vertebral body and a medial laceration of the left vertebral artery at the C5 level; subarachnoid hemorrhage was absent. What initially appeared to be trauma to the neck, worrisome for strangulation or blunt force trauma, was a large retropharyngeal hematoma from the left vertebral artery laceration. Traumatic rupture of the vertebral artery usually occurs at the C1 and C2 levels, with resultant subarachnoid hemorrhage. This is an especially vulnerable location since it is where the artery turns and then enters the skull. Associated injuries include spinal cord transection or contusion, brachial plexus injury, pharyngoesophageal injury, and vertebral fractures. Retropharyngeal hemorrhage may result from deep neck infection, tumor, and trauma. Hemorrhage associated with trauma often involves flexion of the cervical spine, followed by hyperextension. The accumulation of blood slowly impinges on the pharynx/larynx and vasculature structures. The exact injuries and etiology of the hemorrhage must be determined to distinguish strangulation from blunt force trauma. The presentation of signs and symptoms can be helpful in assessing the decedent; however, in the practice of forensic pathology such a history is more often lacking.     

Coronary artery aneurysms in a young adult

Coronary artery aneurysms are an extremely rare cause of death at any age, but particularly so in young adults. A case is described of a young and previously fit man who died suddenly following thrombosis within one of multiple coronary artery aneurysms. He had had a childhood illness with symptoms consistent with an episode of unrecognized infantile polyarteritis nodosa. It is suggested that many cases of aneurysm of the coronary arteries in young adults, where atherosclerosis has been excluded, may in fact be due to previous polyarteritis, rather than of congenital origin as is usually claimed.     

阴茎动脉Doppler超声分析

目的研究健康成年男性阴茎背动脉(DA)、海绵体动脉(CA)PI、RI及S/D的正常值。方法将257名健康成年男性按年龄分为5组,分别为<30岁组65名,30～39岁组83名,40～49岁组61名,50～59岁组38名,60岁以上组10名。用Logidop!2型数字式Doppler超声血流仪检查双侧阴茎背动脉、双侧海绵体动脉PI、RI及S/D值。结果阴茎疲软状态下,阴茎背动脉、海绵体动脉PI、RI和S/D值个体左右比较无差异,各年龄组也无差异。建议正常参考值分别为:(1)LDA:PI1.43～3.43,RI0.72～0.92,S/D2.68～10.56。(2)RDA:PI1.47～3.47,RI0.73～0.93,S/D3.27～10.09。(3)LCA:PI1.49～3.21,RI0.74～0.90,S/D3.17～9.55。(4)RCA:PI1.93～3.27,RI0.72～0.90,S/D3.22～9.42。结论作为一种筛选手段,Doppler超声血流检测手段,有一定的应用价值。     

Cerebral infarct following traumatic carotid artery thrombosis

An autopsy case of a 45-year-old man is presented. The man had sustained a minor head injury in a traffic accident 11 years ago previously and 5 years later had a cerebral infarction due to thrombosis of the carotid artery. There was histological evidence of a traumatic lesion of the vessel wall. Several contradictory expert opinions were rendered regarding the questionable causal relationship between occlusion of the artery and the previous trauma. In the court of appeal, an agreement was arrived at between the widow of the deceased and the third-party insurance of the person responsible for the accident.     

Posttraumatic thrombosis of the middle cerebral artery

Posttraumatic cerebral infarction resulting from carotid or cerebral artery occlusion is rare. Traumatic dissection of the carotid artery is the most frequent cause of infarction, whereas posttraumatic thrombosis of the cerebral artery is very rare. The authors describe a case of posttraumatic thrombosis of the left middle cerebral artery. Early in the morning, a 16-year-old boy was found unconscious in the parking lot of a supermarket. He had received fist blows and kicks to the head, face, body, back, and hip during the night. Computed tomography 10 hours after the violence revealed a gross cerebral infarction in the area of the left middle cerebral artery. He died 9 days after the violence. The autopsy revealed a thrombosis in the left middle cerebral artery. Microscopically, granulation tissue in the intima and a rupture of the internal elastic lamina were observed near the beginning of the artery. It was concluded that the blows to the head and face caused a partial rupture in the arterial wall, leading to thrombosis and cerebral infarction.     

Fatal hemothorax from mycotic celiac artery aneurysm.

We present two cases of ruptured mycotic aneurysms infected with Staphylococcus aureus. Each patient had hemoptysis and in each case there was hemothorax caused by a ruptured mycotic aneurysm of the celiac artery. In case 1, the pathogenesis was transient Staphylococcus aureus septicemia infecting an atherosclerotic plaque with subsequent aneurysm formation and rupture. In case 2, the septicemia arose from an infected knee. The presentation of a celiac artery aneurysm as hemoptysis and as the cause of hemothorax is rare.     

Sudden death related to small coronary artery disease

Two cases of sudden death of young people in apparently good health are reported. The only pathologic change found was a fibromuscular dysplasia of the artery supplying the conduction system of the heart with an important narrowing of the lumen and strong thickening of the arterial wall. The first case was of a 12-year-old girl who died suddenly while skiing; the second was of a 32-year-old man who died while talking to his wife. No other pathologic changes were found at autopsy, and the results of toxicologic analysis were negative. There was no individual or family history of cardiac diseases. These cases illustrate the importance of an analysis of the conduction system, including examination of the intramural coronary arteries supplying the conduction system.     

Sudden death due to ruptured pancreaticoduodenal artery aneurysm

Superior pancreaticoduodenal artery aneurysms are rare; their rupture often leads to sudden death. We report a case of a 59-year-old hypertensive man who died of a massive retroperitoneal hemorrhage following rupture of an aneurysm of the superior pancreaticoduodenal artery. We also discuss this unusual vascular lesion and review the pertinent literature.     

Postmortem angiography of catheter-induced pulmonary artery perforation.

A case of pulmonary artery perforation by the placement of a balloon-tipped, flow-directed (Swan-Ganz) catheter, as demonstrated postmortem by angiography and confirmed by conventional autopsy method, is reported. Angiography is an effective adjunctive modality in the postmortem diagnosis and localization of pulmonary artery perforation. In cases of suspected catheter-induced pulmonary artery perforation and death, postmortem angiography may prove useful to the forensic pathologist.