An autopsy case of sudden death due to acute gastric dilatation without rupture

We report the first autopsy case of fatal gastric dilatation without rupture. A 31-year-old woman who lived alone was found dead in her living room. Despite being very thin, she showed marked abdominal distention. Autopsy and histological findings revealed that a severely distended stomach, of which walls notably thin and displayed transmural necrosis, occupied the entire abdominal cavity. Severe congestion was observed in the intestine and cecum. Theses findings suggest that bulimia nervosa together with anorexia nervosa resulted in rapid dilation of the stomach. We conclude that the cause of death was acute circulatory failure from hypovolemic shock that occurred following compression of the inferior vena cava and superior mesenteric vein, and by loss of circulatory volume to the third space.     

A case of sudden death due to spontaneous coronary artery dissection

Spontaneous dissection of the coronary arteries is an extremely rare event that occurs usually in middle-aged women and is mostly recognized at postmortem examination in victims of sudden death. It is a rare coronary pathologic finding whose precise incidence, etiology, pathogenesis, treatment, and evolution have not been clearly established. We present a sudden death case of a 53-year-old woman with spontaneous dissection of the left anterior descending coronary artery with eosinophilic coronary arteritis.     

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.     

Unusual sudden death: two case reports of hemorrhage by rupture of varicose veins

Although varicose veins are frequent, they are rarely considered lethal. Still, rupture of a varicosity can result in significant and even fatal hemorrhage. External hemorrhage is an unusual complication of this common venous pathology. Reported here are 2 cases of severe external hemorrhage resulting from the perforation of a varicose vein.     

Morbus Fahr--considerations on a case of sudden death

This paper presents 21 cases related to cyanide intoxication by oral ingestion. Cyanide concentrations in biological specimens are especially different from the type of postmortem specimens, and very important in interpreting the cause of death in postmortem forensic toxicology. Besides the detection of cyanide in autopsy specimens, the autopsy findings were unremarkable. Biological samples (0.2mL or equal to less than 10μg of cyanide) were analyzed colorimetrically for cyanide. In a series of 21 cyanide fatalities, the concentration ranges (mean±SD) of cyanide in heart blood, peripheral blood and gastric contents were 0.1-248.6mg/L (38.1±56.6mg/L), 0.3-212.4mg/L (17.1±45.1mg/L) and 2.0-6398.0mg/kg (859.0±1486.2mg/kg), respectively. The ranges of the heart/peripheral blood concentration ratio and gastric contents/peripheral blood concentration ratio were 0.3-10.6 (mean 3.4) and 3.4-402.4 (mean 86.0), respectively. From the difference of cyanide concentration and the concentration ratio of cyanide in different types of postmortem specimens, the possibility of the postmortem redistribution of cyanide and death by oral ingestion of cyanide could be confirmed. We reported cyanide fatal cases along with a review of literature.     

Splenic rupture as a cause of sudden death in undiagnosed chronic myelogenous leukemia

A 35-year-old man died suddenly in a clinic waiting area after repeated visits for flu-like symptoms. At autopsy, hemoperitoneum, splenic capsular rupture, and splenomegaly were found. Microscopic examination, special stains, and immunoperoxidase studies revealed findings consistent with chronic myelogenous leukemia. Spontaneous splenic rupture is an unusual presenting feature of chronic myelogenous leukemia. The symptoms of leukemia may mimic those of other "benign" disorders and misdiagnosis may lead to catastrophic consequences in some instances.     

Coronary artery aneurysm and myocardial infarction resulting in sudden death of a 6 year-old child: a case report

This is a report of a 6-year-old child who died suddenly while at play and without any prior known illness. Autopsy revealed an extensive, fibrotic myocardial infarct involving the apex, diaphragmatic wall of the left ventricle and interventricular septum. The left anterior descending and the right coronary arteries presented with large, bulging calcified aneurysms. The aneurysms showed marked fibrous intimal thickening, atrophy of the media and extensive fragmentation of elastic elements. No evidence of active inflammation was present.     

Vertebral artery rupture in traumatic subarachnoid haemorrhage detected by postmortem angiography

A fatal subarachnoid haemorrhage from a ruptured normal intracranial vertebral artery in a 49-year-old male, following a blow to the head, was revealed by a postmortem angiographic technique using radiopaque silicone rubber as a contrast medium vulcanizing at room temperature. No fracture of the atlas or connection between intracranial vessels and extracranial soft tissue haematoma could be visualized. We advocate the use of postmortem angiography in the diagnosis of suspected head trauma sustained in fights.     

Simultaneous sudden infant death syndrome: a case report.

The first reported case of simultaneous sudden infant death syndrome (SSIDS) in Allegheny County, Pennsylvania, occurred on February 27, 1998. Two-month-old black fraternal twin girls were both found dead in their crib at the same time. After an in-depth death scene investigation, police investigation, toxicologic analysis, and complete autopsies, a specific cause of death could not be identified. The deaths of the two girls were therefore ruled simultaneous sudden infant death syndrome.     

Sudden and unexpected death resulting from splenic artery aneurysm rupture: two case reports of pregnancy-related fatal rupture of splenic artery aneurysm

Rupture of a splenic artery aneurysm is a rare and usually catastrophic event, most commonly associated with pregnancy. In spite of increasingly common reliance on abdominal angiography, magnetic resonance imaging, and computerized tomography during the past quarter century, clinicians uncommonly recognize any of the various splanchnic arterial aneurysms absent premonitory signs or symptoms. Accordingly, rupture of a visceral aneurysm, including splenic artery aneurysm, typically presents as sudden, unexpected obtundation or death. As a consequence, the initial recognition and diagnosis of splenic artery aneurysm rupture take place only at autopsy. This report presents two such cases of sudden death resulting from splenic artery aneurysm in a pregnant woman and a postpartum woman, respectively.     

Marfan syndrome presenting as aortic rupture in a young athlete: sudden unexpected death?

A 20-year-old man had a spontaneous rupture of the ascending aorta while exercising. The diagnosis of Marfan syndrome, established by the gross and microscopic autopsy findings, was further supported by review of the autopsy report of the father, who had died at age 26 of a nearly identical aortic rupture. To avoid occurrences such as the above, the responsibility of the forensic pathologist should extend beyond the autopsy to appropriate counseling of families in instances where medically treatable hereditary conditions may be present in the survivors.     

A rare case of sudden death due to IgG4-related giant coronary artery aneurysms

Immunoglobulin G4-related disease (IgG4-RD) is a fibro-inflammatory condition that can affect many organs, either simultaneously or metachronously. In recent years, IgG4-related vascular complications of larger arteries such as the aorta and iliac arteries have been increasingly identified. Among vascular complications, coronary artery involvement in the forms of either periarteritis or coronary artery aneurysms (CAAs) has also been reported; however, are very rare in comparison. This case report presents a rare case of a sudden death due to occlusive thrombosis of IgG4-related giant CAAs measuring up to 10 cm in diameter, demonstrates their possible clinical progression, and shows how they can distort normal anatomy which may then pose challenges in the interpretation of postmortem-computed tomography scans. It also briefly discusses the diagnosis of IgG4-RD in arteries, both clinically and in the postmortem setting.     

Schizophrenia and sudden death: a medical examiner case study.

This study reviews the causes of sudden death of 66 schizophrenic patients who presented to the Office of the Chief Medical Examiner (OCME) for the State of Maryland over a 3-year period from 1994 through 1996. We identified an increased incidence of suicide compared with the general population of OCME cases. This observation is consistent with reports by other investigators. The majority of the deaths were the result of natural diseases, mostly atherosclerotic cardiovascular disease. Accidents, suicides, and 1 homicide were also present in this group.     

Sudden death in an infant caused by rupture of a basilar artery aneurysm

Ruptured aneurysms of the cerebrovasculature in infancy and early childhood, except for "giant" aneurysms and arteriovenous malformations, are rare. Seizures, loss of consciousness, and apnea are the usual presenting signs in infancy; symptoms such as headache or visual disturbances and signs such as cranial nerve compression or meningeal irritation commonly found in older children or adults are absent in infants. However, the morphologic findings (i.e., subarachnoid and retinal hemorrhage, and occasionally subdural hemorrhage) may be mistaken for inflicted trauma, especially if the aneurysm is not identified. Sudden death caused by rupture of a cerebral aneurysm has not been previously described in an infant. This report outlines the investigation and autopsy findings in a 7-month-old infant who died unexpectedly as a result of rupture of a complex basilar artery aneurysm.     

Unexpected sudden death of a 12-year-old male with congenital single coronary artery

A rare autopsy case of a 12-year-old male with a single coronary artery is reported in which he suddenly and unexpectedly died after a brief period of physical and mental excitation. The single coronary artery originated from the left aortic sinus, then branched out the left circumflex artery and afterwards descended as the left anterior descending artery, while the right coronary artery originated almost at a right angle from the left anterior descending artery. The entire heart as well as the cardiac conduction system depended exclusively on the single coronary artery for oxygenated blood supply, and the unbalanced blood distribution on his exertion probably led to sudden cardiac death. Moreover, in this case, both the deceased's mother (at the age of 20 years) and grandmother on the mother's side died suddenly, thus suggesting a possibility of maternal transmission of this congenital anomaly in his family.     

Numerous cortical tubers and rhabdomyomas in a case of sudden unexpected infant death

Sudden infant death syndrome is the leading cause of death in infants between the ages of 1 month to 1 year. Sudden infant death syndrome, a diagnosis of exclusion, can only be made after other explanations for unexpected death have been ruled out. Tuberous sclerosis complex is occasionally the findings in these patients with unexpected infant death. Here, we present a case of an unexpected infant death during sleep with multiple factors that confound the cause of death. We discuss these factors and attempt to delineate their contributions to arrive at a cause and mechanism of death.     

窦房结中央动脉狭窄与心源性猝死

近年来国内外学者相继报道由单纯窦房结中央动脉狭窄引起的猝死。本文就窦房结中央动脉的解剖、组织学特点、病变特点进行综述,探讨窦房结动脉狭窄引起猝死的机制,以期为相关法医病理学死因鉴定提供理论基础。     

Sudden death in an infant caused by rupture of a basilar artery aneurysm.

Ruptured aneurysms of the cerebrovasculature in infancy and early childhood, except for "giant" aneurysms and arteriovenous malformations, are rare. Seizures, loss of consciousness, and apnea are the usual presenting signs in infancy; symptoms such as headache or visual disturbances and signs such as cranial nerve compression or meningeal irritation commonly found in older children or adults are absent in infants. However, the morphologic findings (i.e., subarachnoid and retinal hemorrhage, and occasionally subdural hemorrhage) may be mistaken for inflicted trauma, especially if the aneurysm is not identified. Sudden death caused by rupture of a cerebral aneurysm has not been previously described in an infant. This report outlines the investigation and autopsy findings in a 7-month-old infant who died unexpectedly as a result of rupture of a complex basilar artery aneurysm.     

A case of sudden infant death due to a primary cardiac sarcoma

The case reported herein concerns the unexpected death of a 3-month-old female newborn who suddenly collapsed in her mother's arms and was dead on arrival at the hospital. The clinical histories of the baby and her parents were negative for symptoms or signs of illness, even those of cardiovascular origin. Furthermore, no clinical appearance of a pathologic status was noted by pediatricians after the birth until the last emergency recovery. The autopsy excluded external and internal signs of violence but revealed a large primary cardiac tumor arising from the free wall of the left ventricle, which had totally invaded the heart causing mitral valve deformation. Histological examination showed a low-grade sarcoma that completely infiltrated the myocardial tissue. The pathogenesis of this sudden infant death was postulated as being owing to a fatal ventricular fibrillation combined with a tumor-related restrictive cardiomyopathy obstructing left ventricular filling.