1例闭合性心脏破裂死亡分析

1简要案情孙某,女,60岁,独居。某年8月24日与他人发生纠纷,被人拳击前胸、四肢,自感胸闷到医院就诊,因经济原因及症状缓解未做特殊检查治疗,当晚回家卧床休息。8月27日,在自家房顶上劳动时倒地死亡。2尸体检验尸长156 cm,发育正常,营养尚可,尸斑颜色较淡位于背部未受压处。左前胸部、左下腹部、左髂前上嵴部、耻骨联合左上方以及双上肢散在大小不等的皮下出血。解剖见:对应左前胸部皮下出血处肋间肌未见出血,肋骨无骨折。心包充盈,心包腔内有约200m l血液及凝血块。心脏表面有大量脂肪组织,左心室后壁近心尖部有一2.4cm的横行破裂口,心外膜…     

闭合性心脏损伤1例

1 案例简介 李某，女，1岁半，某13被其父抱于怀中，面朝其父胸部右侧卧位熟睡乘坐大客车，该客车行至途中与一货车相撞后即死亡。其父全身未见任何损伤。     

拳击胸部致闭合性心脏破裂一例

1 案例闭合性心脏破裂在法医尸检工作中较少见,我们遇到一例拳击胸部所致的闭合性心脏破裂,现报告如下:张某,男,21岁,工人,既往身体健康。1991年4月某日凌晨2点,张某与几个同事酗酒后大嚷大叫,引起了邻居刘某的不满,双方发生纠纷。据目击者陈     

21例胸腹部穿透伤浅析

胸腹部穿透伤指致伤工具穿透胸腹壁进入胸腹腔的创伤。由于致伤工具大小不一,创口大小也不一致,加之创口肌肉收缩,肉眼很难判断是单纯性穿透伤,还是合并内脏器官损伤。因此,胸腹腔探查是诊疗工作中必不可少的手段之一。本文作者就21例胸腹部穿透伤的案例作一浅要分析。1案例资料     

闭合性颅脑损伤致应激性胃溃疡出血死亡1例

1　案例资料赵某 ,男 ,6 3岁 ,农民 ,既往体健 ,无腹痛、返酸及呕吐病史。某日因纠纷与他人发生欧斗 ,头部被撞击在木棍上受伤 ,伤后有短暂昏迷 ,苏醒后诉头昏头痛 ,伴逆行性健忘 ,次日到乡镇卫生院治疗 ,因病情加重抢救无效死亡。入院检查记录 :T36 5℃ ,P76次 /min ,R2 0次 /min ,BP14 / 10Kpa ,一般情况尚可 ,神清合作 ,枕部头皮下有一 4cm× 4cm× 0 5cm的血肿 ,X线片检查示无异常 ,NS(- ) ,医院诊断为 :(1)脑震荡 ;(2 )头皮下血肿。行头孢氨苄 0 2 5tidPO ,VitK38mgBidPO ,甲氰咪呱 0 4BidPO ,云南白药PO治疗 ,同时输止血…     

闭合性腹部损伤致小肠破裂死亡2例

正1案例资料1.1案例1郁某(男,68岁),某日11时,被他人踢腹、臀部后,因腹疼就医,医院未作处理,次日12时病情加剧送至上级医院抢救无效死亡。解剖检验腹腔内大量血性液体,大网膜及肠系膜黏膜出血,表面见菜梗及脓苔。距回盲部220cm的小肠处见1.2cm破裂口,口周见3.0cm×4.5cm肠壁挫伤(图1),肠内容物溢出,肠壁水肿。全脑重1 218g,脑回增宽、脑沟变浅。     

闭合性颅脑损伤死亡63例分析

本文通过对63例在交通事故中因闭合性颅脑损伤而死亡的尸体解剖情况的研究,分析了损伤形成机理及致死原因。发现因脑干损伤死亡25例,占39％;因DAI死亡6例,占9.5％,63例中对冲性颅底骨折20例,占32％。     

闭合性心脏瓣膜损伤的临床法医学鉴定4例

闭合性心脏瓣膜损伤的临床法医学鉴定较为少见,笔者自1 994年8月至2 0 0 2年1 0月受理此类鉴定4例,现报告如下:1　鉴定资料本组共4例,其中男3例,女1例;年龄2 6岁～4 7岁。致伤原因:货物惯性移位砸压押运人1例、货场机动车驾驶者故意撞挤人体1例,列车撞击1例,运行货物列车上抛下     

挤压胸腹部致心脏破裂死一例

<正> 死者邓某,男,22岁,农民。某日在矿井内出矿石,因操作的装岩机不慎失去平衡向一侧倾倒,将邓某挤压于矿井壁上,数分钟后死亡。死后6天尸检。死者发育和营养良好。尸斑呈暗红色,尸僵部分存在,右肘关节伸侧有2×2cm 表皮剥脱,位于右侧胸骨旁线,第二肋间至左侧腋前线乳头上1.5cm 处有13×2cm 横形皮下出血。胸骨体中段     

钝性外力打击胸腹部致心脏破裂死亡1例

1案例资料马某(女,36岁),于2004年12月1日12时许被人骑在身上打击头及胸腹部后死亡。同年12月8日14时进行尸体检验:死者身着衣服较厚,尸长157cm。头顶枕部见一2.5cm×3cm血肿,其间有一2cm创口。右额部稍肿胀,右面部有一6cm×5cm范围浅二度烧伤。双侧睑结膜点状出血,口唇粘膜见1cm×0.5cm硌垫伤,上门牙小部分折断。下颏及颈前见散在皮下出血。解剖所见:顶枕部头皮下广泛出血,颅骨无骨折,硬膜外、硬膜下及蛛网膜下腔未见积血,脑组织无挫伤,颅底完整。颈部肌群广泛出血,以右侧为著,甲状腺呈瘀血状。舌骨、甲状软骨未见骨折,气管及支气管内可见…     

Complete Cardiac Rupture Associated with Closed Chest Cardiac Massage: Case Report and Review of the Literature

Chest skeletal injuries are the most frequent complications of external chest massage (ECM) during cardiopulmonary resuscitation, but heart and great vessels lacerations that are indeed very rare. We report the case of a 35‐year‐old workman who collapsed and underwent ECM by his co‐workers for almost 30 min. At autopsy, no external injuries, fractures or bruises of the ribs or sternum, were observed. A hemopericardium with a rupture of the heart was found, with no signs of pre‐existent cardiac disease. Bruises of thoracic aortic wall, lung petechiae, a contusion of the liver, and bruises of lumbar muscles were found. The cause of death was due to sudden cardiac death with an extensive cardiac rupture. This is an unusual report of massive heart damage without any skeletal or muscle chest injuries, secondary to cardiopulmonary resuscitation. This kind of cardiac lesions may be considered when thoracic–abdominal trauma, or medical history, is unclear.     

Trigemino‐Cardiac Reflex as Lethal Mechanism in a Suicidal Fire Death Case

In the vast majority of immediate fire deaths, the mechanism of death is inhalation of toxic gases (especially carbon monoxide), direct thermal injury, or neurogenic shock due to the redistribution of the body's blood volume produced by surface heat on the skin. We present a suicidal case that is unusual because the mechanism of immediate fire death could arguably be explained in terms of a primitive autonomic reflex/the trigemino‐cardiac reflex. Although this reflex is well known to surgeons and anesthetists, with possible lethal consequences in the course of invasive surgical procedures on the head and neck region, it is much less familiar to forensic pathologists.     

Severe Cardiac Rupture by Only One Blow to the Chest in a Young Boy: An Autopsy Case

Cardiac rupture by blunt chest trauma is commonly seen after motor vehicle accidents and falls; however, it is rarely caused by a blow to the chest. We herein report an autopsy case of a high school boy who sustained severe right ventricular rupture by only one knee kick to the chest during a quarrel. He was hospitalized and developed cardiopulmonary arrest. Emergency surgery was performed, but the patient died. The autopsy revealed no external severe trauma or deformation, but the side wall of the right ventricle contained a large V‐shaped laceration. The other thoracic organs had no injuries. This case illustrates that severe cardiac rupture can occur by only one blow to the chest. Blunt cardiac injuries can occur even if no severe injuries are present on the body surface. We should consider the possibility of severe cardiac injuries regardless of the presence of external injuries.     

178例心源性猝死法医组织病理学诊断分析

目的探讨心源性猝死(SCD)的病理特点与鉴别要点。方法对四川华西法医学鉴定中心2000—2005年尸检出的178例SCD死亡案例进行回顾性分析,主要对其病因、年龄、诱因及病理改变进行分析。结果本组资料显示冠心病、心传导系统病变、心肌炎、心肌病等在SCD中占有较大比例。冠心病猝死是中老年人SCD的最主要原因,青壮年人SCD的病因以非冠心病为主。如传导系统病变、心肌炎、心肌病。在儿童的SCD中先天性心脏病、传导系统病变及心肌炎占主导地位。结论不同的病因,其病理特点不同,其病理变化是法医学鉴定的主要依据。     

Cardiac Inhibitory Reflex as a Cause/Mechanism of Death

The role of cardiac inhibitory reflex as a potential cause of death is still a matter of debate. This study reports two cases of death under unusual circumstances. Case 1 corresponds to a man found hanging where the role of ligature compression of the carotid sinus became relevant as a possible explanation of death. In Case 2, the participation of a vasovagal syncope was clearly triggered by the laryngoscopic procedure. It is proposed that cardiac inhibitory reflex should be taken into account in those cases of unexpected death, which fulfills the following three criteria: (i) The investigation of the circumstances of the death is consistent with a hypothesis of cardiac arrest. (ii) A typical triggering peripheral stimulus is present. (iii) The performance of a complete autopsy cannot rule out the participation of a cardiac inhibitory reflex in the cause of death.     

43例心脏外科手术后死亡医疗纠纷法医学分析

目的 探究心脏外科手术后死亡引起医疗纠纷的原因及特点,重点分析心脏外科手术后病理改变及法医学解剖要点,为心脏外科手术临床诊治及司法鉴定提供病理学证据,为此类案件医疗纠纷防范提供参考.方法 收集中山大学法医鉴定中心2013—2018年受理的心脏外科手术后死亡引发医疗纠纷的法医病理学案件,从死亡原因、病理诊断、手术情况和医...     

Sudden Cardiac Death in a Young Man with Migraine-associated Arrhythmia

A 31-year-old man with migraine-induced syncope and bradycardia with subsequent pacemaker implantation died unexpectedly. Clinically unsuspected cardiac anomalies were found at autopsy including myocardial bridging of the left anterior descending artery and shelf-like coronary artery ostia. Nortriptyline was identified by toxicologic analysis. A review of the autopsy findings, the historical information, and the effects of the possible arrhythmogenic circumstances is undertaken and the potential contributions to the death are discussed. Cardiac arrhythmias have been documented during migraines. Coronary artery bridging has been known to lead to ischemia and infarction, ventricular tachycardia, and sudden death; however, these are very rare sequelae. Congenital coronary artery anomalies have been linked to sudden cardiac death, but only rarely cause death in people younger than 31 years. Migraines and the autopsy findings described have been associated with cardiac arrhythmia and sudden death. Altogether, they led to the unexpected death of this young man.     

一起猝死医疗纠纷协商解决的思考

临床上由于猝死引起的医疗纠纷较为常见.本文剖析了一起典型的由于心肌梗塞猝死引发的医疗纠纷,医患双方从认识上的不一致到尸体解剖后证实了疾病的客观存在,并围绕漏诊、误诊、院方是否存在过失以及患者疾病的特殊性,双方从不同观点展开讨论,最后探讨出协商解决的办法,由医院、PICC和患者家属三方签定了协议,律师见证后生效.     

道路交通事故死亡案例驾驶员损伤特征分析

目的针对交通事故中驾驶员和乘客的损伤,辨别驾驶员损伤的特征性改变,从而为交通事故中准确认定驾驶员提供科学的证据支撑。方法对2006—2014年间,黑龙江省垦区内126例汽车交通事故死亡案例数据进行回顾性研究,分析汽车事故死亡案例驾驶员损伤特征,探讨驾乘人员损伤的法医学鉴定要点。结果驾驶员颈部、胸部、腹部的损伤多见,可检见汽车部件所致特征性损伤。乘员仅头面部及四肢与汽车接触部位有特征性损伤,其他部位未检见可明确汽车部件所致特征性损伤。结论损伤部位、类型与死亡人员的驾乘身份有关。