Asphyxiating death due to basal lingual cyst (thyroglossal duct cyst) in two-month-old infant is potentially aggravated after central catheterization with forced positional changes

There are various causes of possible upper airway obstruction in infants. Particularly, large cysts on the base of tongue may cause severe airway obstruction by a mass effect on the hypopharynx and by displacing the epiglottis. Of these basal lingual cysts, thyroglossal duct cyst is rare but occasionally its remnants can be found at the base of the tongue. Although they are pathologically benign, basal lingual cysts may result in death by asphyxia. There are a few reported cases of asphyxia caused by basal lingual cyst. All died suddenly in the bed or cot while sleeping without any significant symptoms and signs. The authors experienced a unique case of death due to airway obstruction by basal lingual cyst (thyroglossal duct cyst), confirmed by postmortem examination, probably aggravated after central catheterization in 2-month-old infant who had open heart surgery for atrial and ventricular septal defect and report with a literature review.     

Sudden death from saccular laryngeal cyst

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.     

Sudden infant death with periventricular leukomalacia

Periventricular leukomalacia (PVL) is a form of cerebral infarction occurring in neonates, particularly in low-weight and premature infants. PVL is well-known to neonatologists, but generally considered nonfatal. Many infants with PVL die in the hospital with multiple medical problems. Those infants with PVL who survive because of intensive care will have serious motor and sensory deficits, but these problems are rarely recognized before one year of age. When infants with PVL die at home, death seems sudden and unexpected. However, it is important to distinguish death caused by PVL from the Sudden Infant Death Syndrome because the implications for the family are quite different. This case report emphasizes that PVL may be fatal.     

Sudden infant death syndrome in Japan

Two autopsied cases are presented, one involving a 5-month-old infant, and a 6-month-old infant both of whom died suddenly and unexpectedly. The incidence of sudden infant death syndrome in Japan is 1.2 per 1,000 babies live births. Among all cases autopsied in the departments of legal or forensic medicine in 78 universities or colleges of Japan, the incidence was 15 (0.5%) per 3,329 in 1984 and 20 (0.6%) per 3,150 in 1985.     

Toxic environmental factors in sudden infant death (SIDS)

The increasing number of discussions on the influence of toxic environmental factors, including SIDS, prompted systematic postmortem chemical-toxicological investigations to be carried out on 54 SIDS cases and 2 control cases of the same age group. Tissue levels of arsenic, lead, cadmium, mercury, and pentachlorphenol, as well as other organic noxious agents, were measured in several organs. In addition, the COHb concentrations were determined. In spite of the widely scattered values, the extreme levels measured and the arithmetic means and median averages of As, Pb, Cd, Hg, PCP, and COHb had no more range in concentrations than can be expected for toxic effects - according to present knowledge anyway. It was observed that infants from an urban environment showed no greater concentration of noxious agents than did infants from rural regions. There were also no differences between SIDS cases and the controls, nor was there a correlation between infections of the respiratory system that are often morphologically detected - including laryngitis - and higher concentrations of these agents in the organs of SIDS cases.     

Sudden infant death due to asplenia syndrome

An apparently healthy 80-day-old boy died suddenly for no apparent reason. The autopsy revealed that the patient had had congenital asplenia, extensive cardiovascular anomalies, and other organ malformations, including trisegmented lungs, hypoplasia of the corpus callosum and cranial bones, a symmetrical liver, accessory hepatic tissue in the adrenal glands, malrotation of the intestine, and hypoplasia of the greater omentum.     

Sudden infant death, large intestinal volvulus, and a duplication cyst of the terminal ileum

A previously well 7-week-old boy was found unresponsive and cyanotic in his cot in the morning. Resuscitative attempts achieved only partial response with subsequent terminal cardiac arrest occurring later in the day. At autopsy a large intestinal volvulus was found associated with disseminated Clostridium perfringens sepsis. In addition, a duplication cyst of the terminal ileum was present. Although rare, right-sided colonic volvulus may be a cause of unexpected death in infancy. While predisposing factors to volvulus may include intestinal duplication cysts, the anatomic relation of the duplication to the volvulus must be carefully determined before a causal relation can be accepted; the cyst in this case was most likely incidental to the terminal event.     

Sudden death due to a laryngeal cyst.

A 68-year-old woman died suddenly at home; her body was found in an armchair in a sitting position. Autopsy revealed a laryngeal cyst of a dilated secretory gland, located above the vocal cords, which obstructed the glottis, causing asphyxia. A review of the literature with forensic implications is given.     

Sudden infant death syndrome: a subject of medicolegal research

During the last decade, much attention has been paid to the risk factors of sudden infant death syndrome (SIDS). Many researchers have demonstrated that infant-care practices are linked to the risk of SIDS. Prone sleeping, bed sharing, maternal substance abuse, and cigarette smoking have been reported to be significant potentially modifiable risk factors for SIDS. Despite the reports that the incidence of SIDS has decreased by 38% in the United States, it remains the leading cause of death in the first year of life. Deaths resulting from child abuse or neglect inflicted or permitted by their caretakers being second only to SIDS in infant mortalities and some recommendations regarding the differentiation of SIDS and child abuse have generated speculation that some cases of infanticide were misdiagnosed as SIDS. To reach a proper conclusion as to the cause and manner of death of an infant who died suddenly and unexpectedly, investigation must be thorough and professional.     

Sudden infant death in a tropical environment: Singapore's experience

A total of 206 cases of sudden infant deaths examined at the Institute of Science and Forensic Medicine, Singapore, over a 5 year period (1989–1993) were identified to assess the pattern of sudden death in this age group, which was subdivided into the neonatal and post-neonatal periods. A total of 34% (70) of infant deaths occurred in neonatal life and the remaining 66% (136) in the post-neonatal period; 90% of the neonatal deaths were natural, of which over half were due to congenital heart disease and complications of prematurity. Unnatural deaths in this period were uncommon, there being only seven such deaths. In the post-neonatal period, unnatural deaths constituted 25% of the total with trauma and aspiration heading the list. Natural deaths in the post-neonatal period are predominantly due to infections (34%) and a group of sudden natural deaths with minimal findings (31%). The latter group may arguably represent cases of Sudden Infant Death Syndrome (SIDS). The yearly incidence of this group in our study varied between 0.08 to 0.2 per 1000 live births, which is considerably lower than the incidence quoted for Western populations. The criteria for the classification and the impact of sudden infant deaths in Asian countries are discussed.     

Sudden infant death with congenital cytomegalic inclusion disease

Cytomegalic inclusion disease was found in a 5-week-old infant who died unexpectedly. Myocarditis was observed; it was believed to be the cause of this unexpected death.     

Sudden infant death and liver phosphoenolpyruvate carboxykinase analysis

In an effort to substantiate the impaired gluconeogenesis-terminal hypoglycemia hypothesis of sudden infant death syndrome (SIDS), 52 infants ranging from 3 weeks to 7 months of age which had been brought to autopsy were studied. The stomach contents, vitreous humor glucose concentrations, hepatic glycogen content and hepatic phospho-enolpyruvate carboxykinase (PEPCK) activity were measured as part of the laboratory component of the postmortem investigation. The stomach contents, vitreous humor glucose concentrations and liver glycogen content were similar in SIDS/and non-SIDS victims. PEPCK activity was, however, significantly lower in SIDS (p < 0.001) victims and in SIDS with other findings (p < 0.01) victims when compared to non-SIDS victims. Despite the fact that SIDS victims had lower hepatic PEPCK activity and hence potentially lower gluconeogenic capacity, terminal hypoglycemia could not be demonstrated in this group as compared to the SIDS with other findings and the non-SIDS infants. The impaired gluconeogenesis-terminal hypoglycemia hypothesis thus could not be substantiated.     

Sudden infant death due to neurofibromatosis type I

Sudden infant death syndrome (SIDS) is the unexpected death of an infant under the age of 1 year, where a complete autopsy, including scene investigation, fails to reveal a cause of death. Although the frequency of SIDS has decreased almost 50% over the past 10 years, it remains the leading cause of death in infants aged 1 to 6 months. SIDS is a diagnosis of exclusion and requires the elimination of a wide range of possible causes, including asphyxia, poisoning, abuse, occult heart disease, and other natural disease processes. In this report, we describe the case of an infant death initially suspected to be a SIDS death in which autopsy revealed an optic pathway glioma (optic glioma or hypothalamic glioma) and other stigmata of neurofibromatosis type I.     

Sudden death due to an unrecognized cardiac hydatid cyst

Echinococcosis is an endemic disease, most common in sheep-raising communities, usually caused by the larval or cyst stage of the tapeworm Echinococcus granulosus. Isolated cardiac hydatid cyst is uncommon at any age, occurs through the coronary circulation, and accounts for less than 3% of all hydatid disease. We describe a case of an 1%-year-old female, who died suddenly. The post-mortem examination revealed an isolated cyst in the left ventricle of the heart with intact wall. The cytologic examination of the cyst fluid demonstrated the presence of the characteristic scolices and hooklets and established the diagnosis of cardiac hydatid cyst. The present case is of special interest because of the rare primary localization and the onset of sudden death in a young person as the initial manifestation of the disease.     

Sudden death resulting from epidermoid cyst of the brain

Epidermoid cysts of the brain are rare tumor-like lesions, most often of maldevelopmental origin. They are benign in nature, causing symptoms depending on their localization. Surgical resection leads to excellent results. A case is reported of a 68-year-old-man who died suddenly and unexpectedly. Postmortem examination revealed signs of central dysregulation and a bifrontal epidermoid cyst. To the authors' knowledge, death resulting from epidermoid cyst of the brain has not been reported so far.     

Sudden cardiac death in young adults: environmental risk factors and genetic aspects of premature atherosclerosis

Familial hypercholesterolemia (FH) is a genetic disorder that may lead to premature coronary heart disease (CHD) and sudden cardiac death (SCD). Mutations in the LDLR or APOB genes cause FH. We have screened the LDLR and the ligand-binding region of APOB genes in 52 cases of SCD. Deceased patients were younger than 40 years of age and were suspected of having FH. The LDLR and APOB genes were examined via PCR, high-resolution melting, and DNA sequencing. Therein, it was observed that 7.7% of the screened patients exhibited a rare sequence variant in the LDLR gene, with 5.7% suspected of being pathogenic mutations. Lipid profiles and genetic testing for FH could be considered when autopsy reveals significant atherosclerosis of the coronary arteries in young adults. First-degree family members are advised to seek medical advice and testing to determine their own risks of atherosclerosis to prevent premature CHD and SCD.